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WAIVER AND RELEASE OF LIABILITY

IN CONSIDERATION OF the risk of injury that exists while participating in SKATEBOARDING/SURFING (hereinafter the "Activity"); and

IN CONSIDERATION OF my desire to participate in said Activity and being given the right to participate in same;

I HEREBY, for myself, my heirs, executors, administrators, assigns, or personal representatives (hereinafter collectively, "Releasor," "I" or "me", which terms shall also include Releasor's parents or guardian if Releasor is under 18 years of age), knowingly and voluntarily enter into this WAIVER AND RELEASE OF LIABILITY and hereby waive any and all rights, claims or causes of action of any kind arising out of my participation in the Activity; and

I HEREBY release and forever discharge LILJA DWYER, located at 36 Princess St, Sausalito, California 94965, their affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and assigns (collectively "Releasees"), from any physical or psychological injury that I may suffer as a direct result of my participation in the aforementioned Activity.

I AM VOLUNTARILY PARTICIPATING IN THE AFOREMENTIONED ACTIVITY AND I AM PARTICIPATING IN THE ACTIVITY ENTIRELY AT MY OWN RISK. I AM AWARE OF THE RISKS ASSOCIATED WITH PARTICIPATING IN THIS ACTIVITY, WHICH MAY INCLUDE, BUT ARE NOT LIMITED TO: PHYSICAL OR PSYCHOLOGICAL INJURY, PAIN, SUFFERING, ILLNESS, DISFIGUREMENT, TEMPORARY OR PERMANENT DISABILITY (INCLUDING PARALYSIS), ECONOMIC OR EMOTIONAL LOSS, AND DEATH. I UNDERSTAND THAT THESE INJURIES OR OUTCOMES MAY ARISE FROM MY OWN OR OTHERS' NEGLIGENCE, CONDITIONS RELATED TO TRAVEL TO AND FROM THE ACTIVITY, OR FROM CONDITIONS AT THE ACTIVITY LOCATION(S). NONETHELESS, I ASSUME ALL RELATED RISKS, BOTH KNOWN AND UNKNOWN TO ME, OF MY PARTICIPATION IN THIS ACTIVITY.

I FURTHER AGREE to indemnify, defend and hold harmless the Releasees against any and all claims, suits or actions of any kind whatsoever for liability, damages, compensation or otherwise brought by me or anyone on my behalf, including attorney's fees and any related costs.

I FURTHER ACKNOWLEDGE that Releasees are not responsible for errors, omissions, acts or failures to act of any party or entity conducting a specific event or activity on behalf of Releasees. In the event that I should require medical care or treatment, I authorize Lilja Dwyer to provide all emergency medical care deemed necessary, including but not limited to, first aid, CPR, the use o f AEDs, emergency medical transport, and sharing of medical information with medical personnel. I further agree to assume all costs involved and agree to be financially responsible for any costs incurred as a result of such treatment. I am aware and understand that I should carry my own health insurance.

I FURTHER ACKNOWLEDGE that this Activity may involve a test of a person's physical and mental limits and may carry with it the potential for death, serious injury, and property loss. I agree not to participate in the Activity unless I am medically able and properly trained, and I agree to abide by the decision of the Lilja Dwyer official or agent, regarding my approval to participate in the Activity.

I HEREBY ACKNOWLEDGE THAT I HAVE CAREFULLY READ THIS "WAIVER AND RELEASE" AND FULLY UNDERSTAND THAT IT IS A RELEASE OF LIABILITY. I EXPRESSLY AGREE TO RELEASE AND DISCHARGE Lilja DwyerAND ALL OF ITS AFFILIATES, MANAGERS, MEMBERS, AGENTS, ATTORNEYS, STAFF, VOLUNTEERS, HEIRS, REPRESENTATIVES, PREDECESSORS, SUCCESSORS AND ASSIGNS, FROM ANY AND ALL CLAIMS OR CAUSES OF ACTION AND I AGREE TO VOLUNTARILY GIVE UP OR WAIVE ANY RIGHT THAT I OTHERWISE HAVE TO BRING A LEGAL ACTION AGAINST Lilja Dwyer FOR PERSONAL INJURY OR PROPERTY DAMAGE.

To the extent that statute or case law does not prohibit releases for ordinary negligence, this release is also for such negligence on the part of Lilja Dwyer, its agents, and employees.

I agree that this Release shall be governed for all purposes by California law, without regard to any conflict of law principles. This Release supersedes any and all previous oral or written promises or other agreements.

In the event that any damage to equipment or facilities occurs as a result of my or my family's or my agent's willful actions, neglect or recklessness, I acknowledge and agree to be held liable for any and all costs associated with any such actions of neglect or recklessness.

THIS WAIVER AND RELEASE OF LIABILITY SHALL REMAIN IN EFFECT FOR THE DURATION OF MY PARTICIPATION IN THE ACTIVITY, DURING THIS INITIAL AND ALL SUBSEQUENT EVENTS OF PARTICIPATION.

THIS AGREEMENT was entered into at arm's-length, without duress or coercion, and is to be interpreted as an agreement between two parties of equal bargaining strength. Both Participant and Lilja Dwyer agree that this agreement is clear and unambiguous as to its terms, and that no other evidence shall be used or admitted to alter or explain the terms of this agreement, but that it will be interpreted based on the language in accordance with the purposes for which it is entered into. In the event that any provision contained within this Release of Liability shall be deemed to be severable or invalid, or if any term, condition, phrase or portion of this agreement shall be determined to be unlawful or otherwise unenforceable, the remainder of this agreement shall remain in full force and effect. If a court should find that any provision of this agreement to be invalid or unenforceable, but that by limiting said provision it would become valid and enforceable, then said provision shall be deemed to be written, construed and enforced as so limited.

I, THE UNDERSIGNED PARTICIPANT, AFFIRM THAT I AM OF THE AGE OF 18 YEARS OR OLDER, AND THAT I AM FREELY SIGNING THIS AGREEMENT. I CERTIFY THAT I HAVE READ THIS AGREEMENT, THAT I FULLY UNDERSTAND ITS CONTENT AND THAT THIS RELEASE CANNOT BE MODIFIED ORALLY. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND THAT I AM SIGNING IT OF MY OWN FREE WILL.

Date: January 22, 2022

First Student's Name

First Name*

Last Name*

Phone*
First Student's Date of Birth*
I certify that I am 18 years of age or older
First Student's Information
Do you have an injuries?*
No
Yes

Click to customize text box label

Are you joining a summer camp session? If so which week are you interested in? *

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What kind of experience does the student have?*
Brand new/ foundation learning
a little bit/ gaining confidence
confident/ learning tricks

Does the student have any fears or hesitations about learning the board sports?
First Student's Signature*
Second Student's Name

First Name*

Last Name*
Second Student's Date of Birth*
Second Student's Information
Do you have an injuries?*
No
Yes

Click to customize text box label

Are you joining a summer camp session? If so which week are you interested in? *

Click to customize text box label
What kind of experience does the student have?*
Brand new/ foundation learning
a little bit/ gaining confidence
confident/ learning tricks

Does the student have any fears or hesitations about learning the board sports?
Third Student's Name

First Name*

Last Name*
Third Student's Date of Birth*
Third Student's Information
Do you have an injuries?*
No
Yes

Click to customize text box label

Are you joining a summer camp session? If so which week are you interested in? *

Click to customize text box label
What kind of experience does the student have?*
Brand new/ foundation learning
a little bit/ gaining confidence
confident/ learning tricks

Does the student have any fears or hesitations about learning the board sports?
Fourth Student's Name

First Name*

Last Name*
Fourth Student's Date of Birth*
Fourth Student's Information
Do you have an injuries?*
No
Yes

Click to customize text box label

Are you joining a summer camp session? If so which week are you interested in? *

Click to customize text box label
What kind of experience does the student have?*
Brand new/ foundation learning
a little bit/ gaining confidence
confident/ learning tricks

Does the student have any fears or hesitations about learning the board sports?
Fifth Student's Name

First Name*

Last Name*
Fifth Student's Date of Birth*
Fifth Student's Information
Do you have an injuries?*
No
Yes

Click to customize text box label

Are you joining a summer camp session? If so which week are you interested in? *

Click to customize text box label
What kind of experience does the student have?*
Brand new/ foundation learning
a little bit/ gaining confidence
confident/ learning tricks

Does the student have any fears or hesitations about learning the board sports?
Sixth Student's Name

First Name*

Last Name*
Sixth Student's Date of Birth*
Sixth Student's Information
Do you have an injuries?*
No
Yes

Click to customize text box label

Are you joining a summer camp session? If so which week are you interested in? *

Click to customize text box label
What kind of experience does the student have?*
Brand new/ foundation learning
a little bit/ gaining confidence
confident/ learning tricks

Does the student have any fears or hesitations about learning the board sports?
Seventh Student's Name

First Name*

Last Name*
Seventh Student's Date of Birth*
Seventh Student's Information
Do you have an injuries?*
No
Yes

Click to customize text box label

Are you joining a summer camp session? If so which week are you interested in? *

Click to customize text box label
What kind of experience does the student have?*
Brand new/ foundation learning
a little bit/ gaining confidence
confident/ learning tricks

Does the student have any fears or hesitations about learning the board sports?
Eighth Student's Name

First Name*

Last Name*
Eighth Student's Date of Birth*
Eighth Student's Information
Do you have an injuries?*
No
Yes

Click to customize text box label

Are you joining a summer camp session? If so which week are you interested in? *

Click to customize text box label
What kind of experience does the student have?*
Brand new/ foundation learning
a little bit/ gaining confidence
confident/ learning tricks

Does the student have any fears or hesitations about learning the board sports?
Ninth Student's Name

First Name*

Last Name*
Ninth Student's Date of Birth*
Ninth Student's Information
Do you have an injuries?*
No
Yes

Click to customize text box label

Are you joining a summer camp session? If so which week are you interested in? *

Click to customize text box label
What kind of experience does the student have?*
Brand new/ foundation learning
a little bit/ gaining confidence
confident/ learning tricks

Does the student have any fears or hesitations about learning the board sports?
Tenth Student's Name

First Name*

Last Name*
Tenth Student's Date of Birth*
Tenth Student's Information
Do you have an injuries?*
No
Yes

Click to customize text box label

Are you joining a summer camp session? If so which week are you interested in? *

Click to customize text box label
What kind of experience does the student have?*
Brand new/ foundation learning
a little bit/ gaining confidence
confident/ learning tricks

Does the student have any fears or hesitations about learning the board sports?
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.
Insurance

Insurance Carrier*

Insurance Policy Number*
Emergency Contact

In the event of an emergency, please contact the following person(s) in the order presented:


Emergency Contact / Contact Relationship / Contact Telephone *

Emergency Contact / Contact Relationship / Contact Telephone

Emergency Contact / Contact Relationship / Contact Telephone
Do you need gear?
Click to customize question*
No
Yes
Equipment
Wetsuit
Skateboard
other
PARENT / GUARDIAN WAIVER FOR MINORS: In the event that the participant is under the age of consent (18 years of age), then this release must be signed by a parent or guardian, as follows: I HEREBY CERTIFY that I am the parent or guardian of minor(s), named above, and do hereby give my consent without reservation to the foregoing on behalf of this individual.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information
Do you have an injuries?*
No
Yes

Click to customize text box label

Are you joining a summer camp session? If so which week are you interested in? *

Click to customize text box label
What kind of experience does the student have?*
Brand new/ foundation learning
a little bit/ gaining confidence
confident/ learning tricks

Does the student have any fears or hesitations about learning the board sports?
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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