Loading...

 

Release of liability, waiver of claims, assumption of risk and indemnity agreement

 

NOTE:  You will be required to acknowledge and sign the following document on arrival. We may at our discretion refuse service without consequence. You may cancel your participation at anytime in advance of service and you will receive a full refund.

By signing this document you will waive certain legal rights, including the right to sue.  Please read carefully!

I acknowledge the contagious nature of the Coronavirus/COVID-19 and that Health Canada and many other public health authourities recommend practicing social distancing.

I further acknowledge that Naturally Superior Adventures/Rock Island Lodge (The Company) has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19 however The Company can not guarantee that I will not become infected with the Coronavirus/Covid-19.

I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, The Company staff/contractors, and other clients and their families.

I voluntarily seek services provided by The Company and acknowledge that I am increasing my risk to exposure to the Coronavirus/COVID-19.

I acknowledge that I must comply with all set procedures to reduce the spread while participating in any program or service.

 I attest that:
* I am not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell.
* I have not traveled internationally within the last 14 days.
* I do not believe I have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19.
* I have not been diagnosed with Coronavirus/Covid-19 and not yet cleared as non contagious by public health authorities.
* I am following all Health Canada recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19.

I hereby release and agree to hold The Company harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of The Company, or that may otherwise arise in any way in connection with any services received from The Company.

I understand that this release discharges The Company from any liability or claim that I, my heirs, or any personal representatives may have against The Company with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from The Company. This liability waiver and release extends to The Company together with all owners, partners, contractors and employees.

I CONFIRM THAT I HAVE READ AND FULLY UNDERSTAND THIS AGREEMENT AND AM SIGNING FREELY AND VOLUNTARILY AND WITHOUT INDUCEMENT. BY SIGNING THIS AGREEMENT, I ACKNOWLEDGE THAT I AM WAIVING CERTAIN LEGAL RIGHTS WHICH I OR MY HEIRS, EXECUTORS, SUCCESSORS, REPRESENTATIVES AND ASSIGNS MAY HAVE AGAINST THE RELEASEES.

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*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
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*

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!