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PLEASE READ CAREFULLY, THIS IS A RELEASE OF LIABILITY AND WAIVER OF CERTAIN LEGAL RIGHTS. 

In consideration of being allowed to participate in any way in the program, related events and activities, and use of equipment, I undersigned, acknowledge, appreciate, and agree that:

1. I KNOWINGLY AND FREELY ASSUME ALL RISKS OF PARICIPATION, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation. Risks include, but are not limited to: complications from weather or physical exertion: perils and hazards from natural features, plants, animals, insects, wet surfaces, tripping hazards and other man-made or natural features; perils from equipment failure or mis-use; delays in receiving medical attention due to remote locations; opportunities to become lost and failure to adhere to routes or to posted signs. I acknowledge that swimming in the river I not allowed.
2. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS Sebastian Inlet, LLC, its officers, officials, agents and/or employees, other participants, sponsors, advertisers, and, if applicable, owners and lessors of premises used to conduct the event (RELEASEES), from any and all claims, demands, losses, and liability arising out of or related to any INJURY, DISABILITY OR DEATH I may suffer, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law. 

Health Statement

I will notify management or employees of Sebastian Inlet, LLC if I suffer from any medical or health condition that may cause injury to myself, others, or may require emergency care during my participation. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF FISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTANDING THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. 

Date: August 22, 2019

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email*

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Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Additional Adult Participant (18+)

First and Last Name:

Date of Birth:
I agree to the terms and conditions of this waiver
I Agree
Additional Adult Participant (18+)

First and Last Name:

Date of Birth:
I agree to the terms and conditions of this waiver
I Agree
This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liability incidents to my minor child’s involvement or participation in these programs as proved above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by law.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
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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