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SPORT PARTICIPANT RELEASE OF LIABILITY, WAIVER OF CLAIMS, EXPRESS ASSUMPTION OF RISK AND INDEMNITY AGREEMENT

MACKITE WATER SPORTS WAIVER
SPORT PARTICIPANT RELEASE OF LIABILITY, WAIVER OF CLAIMS, EXPRESS ASSUMPTION OF RISK AND INDEMNITY AGREEMENT

Please read and be certain you understand the implications of signing.  By signing below, you are confirming your agreement and understanding of what is stated below.

Express Assumption of Risk Associated with Sport, Venue Use and Related Activities.

I do hereby affirm and acknowledge that I have been fully informed of the inherent hazards and risks associated with activities with Kiteboarding and Foilboarding Lessons, transportation of equipment related to the activities, and traveling to and from activity sites in which I am about to engage. Inherent hazards and risks include but are not limited to:

  1. Risk of injury from the activity and equipment utilized is significant including the potential for broken bones, severe injuries to the head, neck, back and/or surfers’ myelopathy, drowning, or other bodily injuries that my result in permanent disability or death.
  2. Possible equipment failure and/or malfunction or misuse of my own or others’ equipment, which may result in injury, including those injuries described above.
  3. I AGREE THAT I WILL WEAR APPROVED PROTECTIVE GEAR AS DECREED BY THE GOVERNING BODY OF THE SPORT I AM PARTICIPATING IN. However, I understand that protective gear cannot guarantee the participant’s safety. I further agree that no helmet can protect the wearer againstall potential head injuries or prevent injury to: the wearer’s face, neck or spinal cord or from surfers’ myelopathy.
  4. Variation in terrain, wind, temperature and water conditions, including but not limited to waves, currents, shore break, tides, marine life, blowing sand, trees, rocks, other persons and their equipment, and other natural and man-made hazards.
  5. My own negligence and/or the negligence of others, including but not limited to operator error and instructor/guide decision-making including misjudging ocean conditions, weather, equipment or obstacles.
  6. Exposure to the elements and temperature extremes may result in heat exhaustion, heat stroke, sunburn, hypothermia and dehydration.
  7. Dangers associated with exposure to natural elements included but not limited to tsunami, hurricane, inclement weather, thunder and lightning, severe and/or varied winds, temperature, sea conditions and marine life.
  8. Fatigue, exhaustion, chill, and/or dizziness, which may diminish my/our reaction time and increase the risk of accident.
  9. Impact or collision with other participants, athletes, spectators, employees, pedestrians, motor vehicles, and cyclists.

*I understand the description of these risks is not complete and unknown or unanticipated risks may result in injury, illness, or death.

 

Release of Liability, Waiver of Claims and Indemnity Agreement

In consideration for being permitted to participate in the above described activity(ies) and related activities, I hereby agree, acknowledge and appreciate that:

  1. I HEREBY RELEASE AND HOLD HARMLESS WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER CAUSED BY NEGLIGENCE OR OTHERWISE, the following named persons or entities, herein referred to as releasees.
    Mackinaw Kite Company Inc.

    I agree to release the releasees, their officers, directors, employees, representatives, agents, and volunteers from any and all liability and responsibility whatsoever and for any claims or causes of action that I, my estate, heirs, survivors, executors, or assigns may have for personal injury, property damage, or wrongful death arising from the above activities whether caused by active or passive negligence of the releasees or otherwise. By executing this document, I agree to hold the releasees harmless and indemnify them in conjunction with any injury, disability, death, or loss or damage to person or property that may occur as a result of my engaging in the above activities.
     
  2. By entering into this Agreement, I am not relying on any oral or written representation or statements made by the releasees, other than what is set forth in this Agreement.
  3. This agreement shall apply to any and all injury, disability, death, or loss or damage to person or property occurring at any time after the execution of this agreement.

This release shall be binding to the fullest extent permitted by law. If any provision of this release is found to be unenforceable, the remaining terms shall be enforceable.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, I FULLY UNDERSTAND ITS TERMS, I UNDERSTAND THAT I HAVE GIVEN UP LEGAL RIGHTS BY SIGNING IT, AND I SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

I Agree

October 21, 2019

 

 

First Student's Name

First Name*

Last Name*

Phone*
First Student's Date of Birth*
First Student's Information
Any known medical conditions/limitations (heart condition, high blood pressure, diabetes, asthma, etc.) or allergies to plants orinsects (bees, jellyfish, etc.)*
No
Yes

If yes list any known medical conditions/limitations
Are you taking any medication?*
No
Yes

If yes, what medication are you taking?
Are you currently being treated for any medical condition?*
No
Yes

If yes, what medical condition are you receiving treatment for?

Please provide Physicians Name & Physicians Phone No.
First Student's Signature*
Second Student's Name

First Name*

Last Name*
Second Student's Date of Birth*
Second Student's Information
Any known medical conditions/limitations (heart condition, high blood pressure, diabetes, asthma, etc.) or allergies to plants orinsects (bees, jellyfish, etc.)*
No
Yes

If yes list any known medical conditions/limitations
Are you taking any medication?*
No
Yes

If yes, what medication are you taking?
Are you currently being treated for any medical condition?*
No
Yes

If yes, what medical condition are you receiving treatment for?

Please provide Physicians Name & Physicians Phone No.
Third Student's Name

First Name*

Last Name*
Third Student's Date of Birth*
Third Student's Information
Any known medical conditions/limitations (heart condition, high blood pressure, diabetes, asthma, etc.) or allergies to plants orinsects (bees, jellyfish, etc.)*
No
Yes

If yes list any known medical conditions/limitations
Are you taking any medication?*
No
Yes

If yes, what medication are you taking?
Are you currently being treated for any medical condition?*
No
Yes

If yes, what medical condition are you receiving treatment for?

Please provide Physicians Name & Physicians Phone No.
Fourth Student's Name

First Name*

Last Name*
Fourth Student's Date of Birth*
Fourth Student's Information
Any known medical conditions/limitations (heart condition, high blood pressure, diabetes, asthma, etc.) or allergies to plants orinsects (bees, jellyfish, etc.)*
No
Yes

If yes list any known medical conditions/limitations
Are you taking any medication?*
No
Yes

If yes, what medication are you taking?
Are you currently being treated for any medical condition?*
No
Yes

If yes, what medical condition are you receiving treatment for?

Please provide Physicians Name & Physicians Phone No.
Fifth Student's Name

First Name*

Last Name*
Fifth Student's Date of Birth*
Fifth Student's Information
Any known medical conditions/limitations (heart condition, high blood pressure, diabetes, asthma, etc.) or allergies to plants orinsects (bees, jellyfish, etc.)*
No
Yes

If yes list any known medical conditions/limitations
Are you taking any medication?*
No
Yes

If yes, what medication are you taking?
Are you currently being treated for any medical condition?*
No
Yes

If yes, what medical condition are you receiving treatment for?

Please provide Physicians Name & Physicians Phone No.
Sixth Student's Name

First Name*

Last Name*
Sixth Student's Date of Birth*
Sixth Student's Information
Any known medical conditions/limitations (heart condition, high blood pressure, diabetes, asthma, etc.) or allergies to plants orinsects (bees, jellyfish, etc.)*
No
Yes

If yes list any known medical conditions/limitations
Are you taking any medication?*
No
Yes

If yes, what medication are you taking?
Are you currently being treated for any medical condition?*
No
Yes

If yes, what medical condition are you receiving treatment for?

Please provide Physicians Name & Physicians Phone No.
Seventh Student's Name

First Name*

Last Name*
Seventh Student's Date of Birth*
Seventh Student's Information
Any known medical conditions/limitations (heart condition, high blood pressure, diabetes, asthma, etc.) or allergies to plants orinsects (bees, jellyfish, etc.)*
No
Yes

If yes list any known medical conditions/limitations
Are you taking any medication?*
No
Yes

If yes, what medication are you taking?
Are you currently being treated for any medical condition?*
No
Yes

If yes, what medical condition are you receiving treatment for?

Please provide Physicians Name & Physicians Phone No.
Eighth Student's Name

First Name*

Last Name*
Eighth Student's Date of Birth*
Eighth Student's Information
Any known medical conditions/limitations (heart condition, high blood pressure, diabetes, asthma, etc.) or allergies to plants orinsects (bees, jellyfish, etc.)*
No
Yes

If yes list any known medical conditions/limitations
Are you taking any medication?*
No
Yes

If yes, what medication are you taking?
Are you currently being treated for any medical condition?*
No
Yes

If yes, what medical condition are you receiving treatment for?

Please provide Physicians Name & Physicians Phone No.
Ninth Student's Name

First Name*

Last Name*
Ninth Student's Date of Birth*
Ninth Student's Information
Any known medical conditions/limitations (heart condition, high blood pressure, diabetes, asthma, etc.) or allergies to plants orinsects (bees, jellyfish, etc.)*
No
Yes

If yes list any known medical conditions/limitations
Are you taking any medication?*
No
Yes

If yes, what medication are you taking?
Are you currently being treated for any medical condition?*
No
Yes

If yes, what medical condition are you receiving treatment for?

Please provide Physicians Name & Physicians Phone No.
Tenth Student's Name

First Name*

Last Name*
Tenth Student's Date of Birth*
Tenth Student's Information
Any known medical conditions/limitations (heart condition, high blood pressure, diabetes, asthma, etc.) or allergies to plants orinsects (bees, jellyfish, etc.)*
No
Yes

If yes list any known medical conditions/limitations
Are you taking any medication?*
No
Yes

If yes, what medication are you taking?
Are you currently being treated for any medical condition?*
No
Yes

If yes, what medical condition are you receiving treatment for?

Please provide Physicians Name & Physicians Phone No.
Student's 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*
Check to receive information, news, and discounts by email.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
FOR PARTICIPANTS OF MINORITY AGE: This is to certify that I, as Parent, Legal Guardian, Temporary Guardian with legal responsibility for this participant, do consent and agree not only to his/her release of all Releases, but also to release and indemnify the Releasees from any and all liabilities incident to his/her involvement in these programs for myself, my heirs, assigns,and next of kin. If Participant is a Minor, and by their signature, they on my behalf, release all claims that both they and I have.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information
Any known medical conditions/limitations (heart condition, high blood pressure, diabetes, asthma, etc.) or allergies to plants orinsects (bees, jellyfish, etc.)*
No
Yes

If yes list any known medical conditions/limitations
Are you taking any medication?*
No
Yes

If yes, what medication are you taking?
Are you currently being treated for any medical condition?*
No
Yes

If yes, what medical condition are you receiving treatment for?

Please provide Physicians Name & Physicians Phone No.
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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