Loading...

CLEAN OCEAN ACCESS

In consideration of participating in any of the activities outlined in the following section, and for other good and valuable consideration, I hereby agree to release and discharge from liability Clean Ocean Access (COA) while doing business with the organization and its partners as well as  its owners, directors, officers, employees, agents, volunteers, participants, and all other persons or entities acting for them (hereinafter collectively referred to as "releases"), on behalf of myself and my children, parents, heirs, assigns, personal representative and estate, and also agree as follows:

In consideration of the activities arranged by Clean Ocean Access, their agents or employees, officers, volunteers, participants, and all other persons or entities acting in any capacity by, through, under or on behalf of Clean Ocean Access (hereinafter collectively referred to as "COA"), which are in any way connected with my participation in any activity with COA or my use of any COA supplied equipment or facilities, including but not limited to those alleging negligent acts or omissions. 

I hereby agree to release, indemnify, and discharge COA, on behalf of myself, my spouse, my children, my parents, my heirs, assigns, personal representative and estate as follows: I acknowledge that my participation in anything associated with COA presents both known and unanticipated risks that could result in physical, emotional injury or death. 

I understand that such risks simply cannot be eliminated entirely without jeopardizing the essential needs of the activity. The risks include, among other things: hazards of slips and falls; cuts, abrasions and infections; health problems caused by exposure to the elements and weather; my own physical condition, and the physical exertion associated with this activity. I expressly agree and promise to accept and assume all of the risks existing in this activity. My participation in this activity is purely voluntary, and I elect to participate in spite of the risks.  

I have read and understand the safety tips for this event. By signing this document, I acknowledge that if anyone is hurt, or property is damaged or lost during my participation in this activity, I waive my right to maintain a lawsuit against COA on the basis of any claim from which I have released them herein. 

By supplying an email address I agree to receive news and notification of other COA events and activities. My address will not be knowingly shared or distributed to other organizations I irrevocably give, grant, and convey to COA, its successors, agents, and assigns, without compensation to me from any party including COA, the absolute right and unrestricted permission to copyright and/or use and/or publish (1) my name, (2) my image or likeness on videotape or digital imaging, and (3) photographic pictures or portraits of me or in which I may be included, in whole or in part, on reproductions in color or in black and white, made through any media, in connection with photos or videotape taken of me at a COA event for any purpose whatsoever, including but not limited to the promotion of COA.  I further waive any right that I may have to inspect or approve the finished product. The videotape, photographs, and negatives will be the sole property of the COA.  

I have read the foregoing and fully understand its contents.  I also understand that this permission is binding on my heirs, successors, and assigns.  If I am under 18 years of age I confirm that my parent or guardian has understood the nature of all COA events and agreed for me to participate.  

First Participant's Name

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Participant'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 e-mail.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
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*

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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!