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CLUB RELEASE OF LIABILITY WAIVER

Term: 01/01/2020 - 01/01/2021

In consideration of being allowed to participate in any way in this sports activity, related events and activities, the undersigned acknowledges, appreciates, and agrees that: The risk of injury and illness, from the activities involved in this sport may be significant, including the potential for permanent paralysis and death; and while particular rules, equip-ment, and personal discipline may reduce this risk, the risk of serious injury or illness does exist; and, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others and assume full responsibility for my participation; I willingly agree to comply with the stated and customary terms and conditions for participation.

If, however,I observe any unusual or significant hazard during my presence o rparticipation, I will remove myself from participation and bring such hazard to the attention of the nearest official immediately; and,I,for myself and on behalf of my heirs,assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS PADDLESPORT RISK MANAGEMENT, LLC;NATIONAL CAPITAL AREA WOMENS PADDLING ASSOC.; GOVERNMENT OF THE DISTRICT OF COLUMBIA OFFICE OF DEPUTY MAYOR FOR PLANNING AND ECONOMIC DEVELOPMENT; ANACOSTIA COMMUNITY BOATHOUSE; their officers & directors, officials, agents, and/or employees, other participants, sponsoring agencies, commissions, sponsors, advertisers, volunteers, coaches, steerers, and, if applicable, owners and lessors of premises used to conduct the event (“RELEASEES”),WITH RESPECT TO ANY AND ALL INJURY, SICKNESS, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE.

I also acknowledge that photographs and video may be taken of me in my participation in, and attendance at this event, and hereby freely agree to allow without restriction all uses of such photos and videos in the reporting of this race, and/or in the promotion of this event, its location, other sporting events, sport in general, and/or related purposes. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND I understand that videos and photos may be taken by event host/club. I further agree to the release of photographic and video media.

Date: October 20, 2020

First Participant/Member's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant/Member's Date of Birth*
First Participant/Member's Information

Guest Paddler Participation Date:
First Participant/Member's Signature*
Second Participant/Member's Name

First Name*

Middle Name

Last Name*
Second Participant/Member's Date of Birth*
Second Participant/Member's Information

Guest Paddler Participation Date:
Third Participant/Member's Name

First Name*

Middle Name

Last Name*
Third Participant/Member's Date of Birth*
Third Participant/Member's Information

Guest Paddler Participation Date:
Fourth Participant/Member's Name

First Name*

Middle Name

Last Name*
Fourth Participant/Member's Date of Birth*
Fourth Participant/Member's Information

Guest Paddler Participation Date:
Fifth Participant/Member's Name

First Name*

Middle Name

Last Name*
Fifth Participant/Member's Date of Birth*
Fifth Participant/Member's Information

Guest Paddler Participation Date:
Sixth Participant/Member's Name

First Name*

Middle Name

Last Name*
Sixth Participant/Member's Date of Birth*
Sixth Participant/Member's Information

Guest Paddler Participation Date:
Seventh Participant/Member's Name

First Name*

Middle Name

Last Name*
Seventh Participant/Member's Date of Birth*
Seventh Participant/Member's Information

Guest Paddler Participation Date:
Eighth Participant/Member's Name

First Name*

Middle Name

Last Name*
Eighth Participant/Member's Date of Birth*
Eighth Participant/Member's Information

Guest Paddler Participation Date:
Ninth Participant/Member's Name

First Name*

Middle Name

Last Name*
Ninth Participant/Member's Date of Birth*
Ninth Participant/Member's Information

Guest Paddler Participation Date:
Tenth Participant/Member's Name

First Name*

Middle Name

Last Name*
Tenth Participant/Member's Date of Birth*
Tenth Participant/Member's Information

Guest Paddler Participation Date:
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*
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
FOR PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT THE TIME OF REGISTRATION) This is to certify that I, as parent/legal 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 liabilities incident to my minor child’s involvement or participation in these programs as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by law.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Guest Paddler Participation Date:
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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