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Waiver for Dutch Springs Staff for the 2019 Season

This waiver must be filled out by the Adult Participant or the Parent/Legal Guardian of the Minor Participant.

THE UNDERSIGNED understands and acknowledges that permission to enter DUTCH SPRINGS is granted only after the written document is completed and signed. PLEASE READ THE DOCUMENT CAREFULLY.

IN CONSIDERATION of the opportunity afforded to me, or a minor child for whom I am parent or guardian, to enter and utilize  the premises known as DUTCH SPRINGS located in Lower Nazareth and Bethlehem Townships, Northampton County, PA and to  participate in FREEDIVING and/or SCUBA DIVING, its associated activities and/or AQUAPARK or other  water  activities  and/or  AERIAL PARK or other land based activities and/or KNOCKERBALL® activities, I hereby assume all risk of loss or injury to my person, or to said minor child, and/or my or their property that may be sustained in connection with such activities or related activities, including specifically rental and/or use of equipment, if applicable, in and about those premises.  I acknowledge that there is no lifeguard on duty except within the AQUAPARK area, and that I have been given an opportunity to inspect the property and my, or said minor child’s, use of the premises indicates my satisfaction with the condition of same.

IN CONSIDERATION of the permission granted to me, or to said minor child, to enter the premises and/or participate in such activities, I, for myself, or said minor child, our respective heirs, administrators, executors, successors and assigns, do hereby release, remise and forever discharge RECREATIONAL CONCEPTS DEVELOPMENT CORP., d/b/a DUTCH SPRINGS and hereinafter referred to as DUTCH SPRINGS, the owners, operators, sponsors of any event, as well as their respective agents, servants, employees, officers, officials, and other participants in those activities of and from all claims, demands, actions and causes of action of any sort, in law or equity, arising from any injury, including death, sustained to my person or the person of said minor child and/or property arising during or from my, or said minor child’s, participation in any of the aforesaid activities and/or presence on the premises.

I INTEND by this Release to waive all claims for negligence, products liability, or breach of warranty against DUTCH SPRINGS, including claims for personal injury to me or said minor child or damage to my or said minor child’s property whether or not based on the  sole negligence of DUTCH SPRINGS, its agents or its employees. This Release shall cover and include all areas, activities and acts, within the premises, including but not limited to, all recreational endeavors, activity in the AQUAPARK, activity in the AERIAL PARK, KNOCKERBALL®, parking facilities, picnicking areas, land, showers, rest rooms, office and every other area, activity, or act in or about DUTCH SPRINGS or connected with the same. I INTEND for all terms of this Release and Waiver of Liability Agreement to extend to those situations where MOBILE ZIPLINE and/or ULTIMATE JUMPER and/or KNOCKERBALL® activities involving equipment owned by DUTCH SPRINGS are being conducted at locations away from the DUTCH SPRINGS premises.

I AGREE to indemnify and hold harmless DUTCH SPRINGS from any and all causes of action at law or in equity arising out of such activities that I, said minor child, any personal representatives, and/or my or said minor child’s heirs, executors, administrators, successors or assigns, may have or assert against DUTCH SPRINGS and I AGREE to pay all costs of such action, including but not limited to attorney’s fees incurred by DUTCH SPRINGS in the defense of same.

I ACKNOWLEDGE that the utilization of the premises, including equipment, by me, or said minor child, for whatever purpose is purely at my risk. I agree that there have been no warranties made to me expressed or implied. I represent and certify that I am eighteen (18) years of age or older and certify that my, or said minor child’s, attendance and participation in these activities is voluntary. I represent and certify that my, or said minor child’s, participation in FREEDIVING and/or SCUBA DIVING is as a certified scuba diver, or in the instance of PADI/SCUBA DIVER under the supervision of a qualified SCUBA instructor, or as a student in a FREEDIVING and/or SCUBA DIVING course/program under the supervision of a qualified FREEDIVING and/or SCUBA instructor.

I ACKNOWLEDGE that by entering the premises and/or utilizing the equipment, DUTCH SPRINGS is granted permission to use any film, photograph, videotape or audio recording in which I or said minor child appear for any legitimate business purpose without payment to any person.

I AGREE that this Release shall be continuing in nature for subsequent visits by me, or said minor child, during the calendar year of the date of my signature or for the duration of the season if a Season Pass is purchased.

I INTEND AND AGREE that this Release and Waiver of Liability Agreement will be governed by Pennsylvania law and will be binding upon my or said minor child’s estate, heirs, administrators, executors, successors and assigns, and legal personal representatives. I AGREE that any dispute relating to this Agreement will be resolved exclusively in the Courts of the Commonwealth of Pennsylvania.

I HAVE READ AND UNDERSTOOD THE FOREGOING RELEASE AND, BY AFFIXING MY SIGNATURE TO IT, SIGNIFY MY CLEAR INTENTION TO BE LEGALLY BOUND BY IT. THIS AGREEMENT, AS PUBLISHED AND POSTED AT WWW.DUTCHSPRINGS.COM SHALL NOT BE AMENDED OR MODIFIED OR ANY OF ITS PROVISIONS WAIVED, UNLESS IN WRITING AND SIGNED BY THE DULY AUTHORIZED REPRESENTATIVES OF BOTH PARTIES.

December 10, 2019

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First Staff Name

First Name*

Middle Name

Last Name*
First Staff Date of Birth*
First Staff Information

Home Phone Number

Cell Phone Number

Other Phone Number (please indicate type)

Type of Scuba Certification- ie Open Water, Advanced Open Water, Nitrox,...

Diver Number or Certification Card ID
Scuba Certifying Agency

If "Other", please write your agency here

Scuba Certification Date
Nitrox Certification Type

Nitrox Certification Number, if applicable
Nitrox Certifying Agency, if applicable

If "Other", please write your nitrox agency here, if applicable

Nitrox Certification Date, if applicable
Solo Diving Certified?*
No
Yes

Solo Diver Certification Number, if applicable
Liability Insurance Agent Name

Liability Insurance Policy or Certificate Number

Liability Insurance Start Date

Liability Insurance End Date
Red Cross Certified Lifeguard?*
No
Yes

Red Cross Lifeguard Certification Number, if applicable
EMT or Paramedic?*
No
Yes

EMT/Paramedic Certification Information and Number, if applicable
Primary Job Area*
Secondary Job Area

Emergency Contact Name *

Relationship to Emergency Contact *

Emergency Contact Phone Number *

Year Hired *
First Staff Signature*
Staff Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Must check this for staff info.
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Relationship*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Home Phone Number

Cell Phone Number

Other Phone Number (please indicate type)

Type of Scuba Certification- ie Open Water, Advanced Open Water, Nitrox,...

Diver Number or Certification Card ID
Scuba Certifying Agency

If "Other", please write your agency here

Scuba Certification Date
Nitrox Certification Type

Nitrox Certification Number, if applicable
Nitrox Certifying Agency, if applicable

If "Other", please write your nitrox agency here, if applicable

Nitrox Certification Date, if applicable
Solo Diving Certified?*
No
Yes

Solo Diver Certification Number, if applicable
Liability Insurance Agent Name

Liability Insurance Policy or Certificate Number

Liability Insurance Start Date

Liability Insurance End Date
Red Cross Certified Lifeguard?*
No
Yes

Red Cross Lifeguard Certification Number, if applicable
EMT or Paramedic?*
No
Yes

EMT/Paramedic Certification Information and Number, if applicable
Primary Job Area*
Secondary Job Area

Emergency Contact Name *

Relationship to Emergency Contact *

Emergency Contact Phone Number *

Year Hired *
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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