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PARENTAL CONSENT, WAIVER OF LIABILITY, ASSUMPTION OF RISK & INDEMNIFICATION AGREEMENT FOR PARTICIPANT OF MINOR AGE

The undersigned has read the above waiver/release, understands that they have given up substantial rights by signing and has signed voluntarily. In consideration for my child participating in any Ecological Marine Adventures, Topsail Island (hereinafter referred to as “EMA”) activities, programs or classes, whether free or for cost (hereinafter referred to as “Activities”) and recognizing the possibility of physical injury, mental injury, property damage or loss, disability and/or death associated with the Activities, I, the undersigned parent or legal guardian for the minor child(ren) listed below hereby release, waive, discharge and agree to hold harmless and indemnify EMA, its owners, agents, employees, personnel, associates and representatives against any and all claims of liability [to include attorney fees or any other related expenses] by, or on behalf of, my participant minor child, arising out of, or in connection with, my child’s participation in any and all EMA Activities, whether due to ordinary negligence, fault, or any other act, omission or occurrence which causes the resulting injury, disease, death or damage. I hereby give my permission for my child to participate in the Activities, and I voluntarily agree to release, indemnify and hold harmless EMA and its owners, agents, employees, personnel, associates and representatives from any and all claims of liability as to my child(ren) or myself, my family, my heirs, assigns, personal representatives or next of kin for any damages, losses or injuries that may arise from my child(ren)’s participation in, or connection with, the Activities.

ASSUMPTION OF RISK

I, parent/guardian of participant minor child(ren), understand the inherent risks associated with participating in the Activities. I further acknowledge such risks include but are not limited to: Drowning, rip currents, strong tides, Jelly fish, stingray stings, and other marine life, injuries related to crossing the street, scrapes, burns and bruises, heat stroke, allergic reactions, slips, trips and falls, concussion or other head injury, mouth, facial or dental/tooth injury, permanent disability, mental injury, disfigurement, paralysis and/or death. I understand that the aforementioned is a limited list of potential risks associated with participating in EMA Activities. I further understand and agree that EMA makes no warranty regarding ocean or weather conditions, or actions of third parties, and I hereby acknowledge and assume any such risk. By signing this release, I acknowledge and assume all risk for any and all injuries, damage or loss arising out of my child(ren)’s participation in the Activities, whether the result of ordinary negligence or any other cause, including unforeseeable risks, and I further release, hold harmless and indemnify EMA from any and all claims of liability.

COVENANT NOT TO SUE

I, parent/guardian of said minor child(ren), by signing this Release, knowingly and voluntarily agree and covenant not to sue EMA, its owners, agents, associates, employees, personnel or representatives for any and all loss or damage myself or my child may experience, including but not limited to property damage, physical injury, permanent disability or death, arising out of, or in any way connected with, my child’s participation in the Activities.

SEVERABILITY

I further agree that if any provision of this Waiver and Release shall be deemed unenforceable for any reason, the validity of all remaining provisions shall remain in full force and effect. I, the undersigned parent/guardian of the participant minor child(ren) listed below, certify that I have read, understand, agree and voluntarily sign this PARENTAL CONSENT, WAIVER OF LIABILITY, ASSUMPTION OF RISK, RELEASE & INDEMNIFICATION AGREEMENT FOR PARTICIPANTOF MINOR AGE, to apply to each of the below participant minor children, for any and all EMA Activities for which they are registered, and I understand that this waiver shall remain in full force and effect for perpetuity, for any and all EMA Activities they participate in.    

PARENT/GUARDIAN CONSENT TO TREAT AND MEDICAL RELEASE

I, the undersigned parent/guardian of minor child(ren) hereby give my permission for any EMA owner, employee, agent, personnel or otherwise designated individual to administer treatment in the event of illness, injury, emergency or accident, including but not limited to, first aid. I further give my permission for EMA to secure emergency medical treatment for my child should the need arise, and I acknowledge and understand that any resulting emergency medical expenses for the participant minor child are the sole responsibility of the participant. I understand that EMA will make its best, appropriate efforts to contact myself or other authorized emergency contact in the event of such emergency. By signing this Release, I certify that there are no health related problems or limitations which would preclude or restrict my child’s participation in any EMA activities, programs and/or classes. I further hereby represent that I have informed EMA of any and all relevant medical conditions that may affect my child’s participation in EMA activities, programs and/or classes.

ECOLOGICAL MARINE ADVENTURES, TOPSAIL ISLAND PERMISSION TO USE PHOTOGRAPHY

I, the undersigned parent/guardian of participant minor child(ren) listed below, hereby agree, understand and voluntarily give my permission, in perpetuity, for Ecological Marine Adventures, Topsail Island (“EMA”) to use photographs and video records of my child for promotional and/or commercial purposes, including but not limited to: print ads, social media, websites or other modes of marketing, without compensation to me.

I, the undersigned parent/guardian of participant minor child, have read and fully understand and agree to all of the foregoing terms and provisions contained on both pages and all sections in this PARENTAL CONSENT, WAIVER OF LIABILITY, ASSUMPTION OF RISK, RELEASE AND INDEMNIFICATION AGREEMENT, COVENANT NOT TO SUE, SEVERABILITY, PARENT/GUARDIAN CONSENT TO TREAT AND MEDICAL RELEASE, ECOLOGICAL MARINE ADVENTURES, TOPSAIL ISLAND PERMISSION TO USE PHOTOGRAPHY FOR PARTICIPANT(S) OF MINOR AGE, and I voluntarily sign this Agreement on my own behalf and on behalf of my minor child(ren).

Today's Date: November 14, 2019

First Participant's Name

First Name*

Last Name*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
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*

Confirm Email*
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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*

Last Name*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
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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