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Silent Wake, LLC
Release and Acknowledgment of Risk

In consideration of the services of Silent Wake, LLC, its owners, agents, officers, volunteers, participants, employees, and all other persons or entities acting on its behalf. I hereby agree to release and discharge Silent Wake, LLC, on behalf of myself, my parents, my heirs, assigns, personal representatives and estate as follows:

1. I acknowledge that sea kayaking, stand up paddle boarding, canoeing, camping, hiking, sailing, and other adventure activities, including travel into remote areas entails known and unanticipated risks which could result in severe physical or emotional injury, paralysis, death, or damage to myself, to property, or to third parties. I understand that such risks simply cannot be eliminated without compromising the essential qualities of the activity.

These risks include, but are not limited to: capsize, collision with objects or other watercraft, exposure to turbulent water, rain, and cold, contact with poisonous or injurious plants, venomous and/or aggressive animals, and illness in remote areas where definitive medical care might be delayed. These and other unforeseen risks could result in severe injury or death from hypothermia, accidental drowning, or trauma to skeletal, muscular, nervous, circulatory, respiratory and lymphatic systems.

Furthermore, Silent Wake, LLC guides have difficult jobs to perform. They seek safety, but are not infallible. They might be ignorant of a participant’s fitness or abilities. The might misjudge the weather, the elements or the terrain. They may give inadequate warnings or instructions, and the equipment being used might malfunction.

2. I expressly agree to accept and assume all the risks existing in this activity. My participation in the activity is purely voluntary, and I elect to participate in spite of the risks.

3. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless Silent Wake, LLC from any and all claims, demands, or causes of actions, which are in any way connected with my participation in this activity or my use of Silent Wake’s equipment or facilities, including any such claims which alleged negligent acts or omissions of Silent Wake, LLC.

4. I certify that I have insurance to cover any injury or damage I might cause or suffer while participating, or else I agree to bear the costs of such injury or damage myself. I further certify that I have no medical or physical conditions which could interfere with my safety in this activity, or else I am willing to assume, and bear the cost of, all rights that may be created, directly or indirectly, by any such condition.

5. In the event that I file a lawsuit against Silent Wake, LLC, I agree to do so solely in the State of Wisconsin, and agree that the substantive laws of that state shall apply in that action. I agree to indemnify and hold Silent Wake, LLC harmless for all costs and attorney’s fees incurred to enforce this agreement.

I have had sufficient opportunity to read this entire document. I have read and understood it and agree to be bound by its terms. 

Media/Photo Waiver: Undersigned authorizes and gives full consent to released parties to copyright and/ or publish for public view any and all photographs, digital recordings, videotapes, and/or film in which participant appears. Undersigned agrees the released parties may transfer, use, or cause to be used, these photographs, digital recordings, videotapes, or films for any exhibitions, public displays, publications, commercials, art and advertising purposes, television programs, and internet without limitations or reservations. 

 

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Information

ACA # (if available)
What size life vest (PFD) will you need?*
Type of kayak needed?*
Your paddle skills*
Health Condition(s) - select all that apply *
Motion sickness/seasickness
Insect allergies
Heart Disease
High blood pressure
Chest pain with exertion
Have you had a heart attack or stroke
Diabetic
Asthma
Dislocations
Epilepsy
Currently pregnant
Muscle, joint, or bone issues which would impede your ability to kayak
Recent surgery in the past 6 months
Recent illness in the past 14 days
None of the above apply
First Participant's Signature*
Second Participant's Name

First Name*

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

ACA # (if available)
What size life vest (PFD) will you need?*
Type of kayak needed?*
Your paddle skills*
Health Condition(s) - select all that apply *
Motion sickness/seasickness
Insect allergies
Heart Disease
High blood pressure
Chest pain with exertion
Have you had a heart attack or stroke
Diabetic
Asthma
Dislocations
Epilepsy
Currently pregnant
Muscle, joint, or bone issues which would impede your ability to kayak
Recent surgery in the past 6 months
Recent illness in the past 14 days
None of the above apply
Third Participant's Name

First Name*

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

ACA # (if available)
What size life vest (PFD) will you need?*
Type of kayak needed?*
Your paddle skills*
Health Condition(s) - select all that apply *
Motion sickness/seasickness
Insect allergies
Heart Disease
High blood pressure
Chest pain with exertion
Have you had a heart attack or stroke
Diabetic
Asthma
Dislocations
Epilepsy
Currently pregnant
Muscle, joint, or bone issues which would impede your ability to kayak
Recent surgery in the past 6 months
Recent illness in the past 14 days
None of the above apply
Fourth Participant's Name

First Name*

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

ACA # (if available)
What size life vest (PFD) will you need?*
Type of kayak needed?*
Your paddle skills*
Health Condition(s) - select all that apply *
Motion sickness/seasickness
Insect allergies
Heart Disease
High blood pressure
Chest pain with exertion
Have you had a heart attack or stroke
Diabetic
Asthma
Dislocations
Epilepsy
Currently pregnant
Muscle, joint, or bone issues which would impede your ability to kayak
Recent surgery in the past 6 months
Recent illness in the past 14 days
None of the above apply
Fifth Participant's Name

First Name*

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

ACA # (if available)
What size life vest (PFD) will you need?*
Type of kayak needed?*
Your paddle skills*
Health Condition(s) - select all that apply *
Motion sickness/seasickness
Insect allergies
Heart Disease
High blood pressure
Chest pain with exertion
Have you had a heart attack or stroke
Diabetic
Asthma
Dislocations
Epilepsy
Currently pregnant
Muscle, joint, or bone issues which would impede your ability to kayak
Recent surgery in the past 6 months
Recent illness in the past 14 days
None of the above apply
Sixth Participant's Name

First Name*

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

ACA # (if available)
What size life vest (PFD) will you need?*
Type of kayak needed?*
Your paddle skills*
Health Condition(s) - select all that apply *
Motion sickness/seasickness
Insect allergies
Heart Disease
High blood pressure
Chest pain with exertion
Have you had a heart attack or stroke
Diabetic
Asthma
Dislocations
Epilepsy
Currently pregnant
Muscle, joint, or bone issues which would impede your ability to kayak
Recent surgery in the past 6 months
Recent illness in the past 14 days
None of the above apply
Seventh Participant's Name

First Name*

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

ACA # (if available)
What size life vest (PFD) will you need?*
Type of kayak needed?*
Your paddle skills*
Health Condition(s) - select all that apply *
Motion sickness/seasickness
Insect allergies
Heart Disease
High blood pressure
Chest pain with exertion
Have you had a heart attack or stroke
Diabetic
Asthma
Dislocations
Epilepsy
Currently pregnant
Muscle, joint, or bone issues which would impede your ability to kayak
Recent surgery in the past 6 months
Recent illness in the past 14 days
None of the above apply
Eighth Participant's Name

First Name*

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

ACA # (if available)
What size life vest (PFD) will you need?*
Type of kayak needed?*
Your paddle skills*
Health Condition(s) - select all that apply *
Motion sickness/seasickness
Insect allergies
Heart Disease
High blood pressure
Chest pain with exertion
Have you had a heart attack or stroke
Diabetic
Asthma
Dislocations
Epilepsy
Currently pregnant
Muscle, joint, or bone issues which would impede your ability to kayak
Recent surgery in the past 6 months
Recent illness in the past 14 days
None of the above apply
Ninth Participant's Name

First Name*

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

ACA # (if available)
What size life vest (PFD) will you need?*
Type of kayak needed?*
Your paddle skills*
Health Condition(s) - select all that apply *
Motion sickness/seasickness
Insect allergies
Heart Disease
High blood pressure
Chest pain with exertion
Have you had a heart attack or stroke
Diabetic
Asthma
Dislocations
Epilepsy
Currently pregnant
Muscle, joint, or bone issues which would impede your ability to kayak
Recent surgery in the past 6 months
Recent illness in the past 14 days
None of the above apply
Tenth Participant's Name

First Name*

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

ACA # (if available)
What size life vest (PFD) will you need?*
Type of kayak needed?*
Your paddle skills*
Health Condition(s) - select all that apply *
Motion sickness/seasickness
Insect allergies
Heart Disease
High blood pressure
Chest pain with exertion
Have you had a heart attack or stroke
Diabetic
Asthma
Dislocations
Epilepsy
Currently pregnant
Muscle, joint, or bone issues which would impede your ability to kayak
Recent surgery in the past 6 months
Recent illness in the past 14 days
None of the above apply
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
Check to receive information, promotions and events by e-mail.
A signed copy of this waiver will be sent to the email address you provide.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
To better serve you, some additional questions:

Date of desired session *
Are you a returning customer? If so, give us a call before you make a payment.*
What body of water would you like to paddle?*
How many miles (if this is for a guided trip) are you looking to paddle?*
How did you hear about us?*
For participants under the age of 16: In consideration of (minor’s name) being permitted to participate in Silent Wake, LLC activities and to use its equipment and facilities, I further agree to hold Silent Wake, LLC harmless for any and all related claims brought by, or on behalf of this Minor.


By signing below the parent or court-appointed legal guardian agrees that they are also 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 Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information

ACA # (if available)
What size life vest (PFD) will you need?*
Type of kayak needed?*
Your paddle skills*
Health Condition(s) - select all that apply *
Motion sickness/seasickness
Insect allergies
Heart Disease
High blood pressure
Chest pain with exertion
Have you had a heart attack or stroke
Diabetic
Asthma
Dislocations
Epilepsy
Currently pregnant
Muscle, joint, or bone issues which would impede your ability to kayak
Recent surgery in the past 6 months
Recent illness in the past 14 days
None of the above apply
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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