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The Boardwalk and Emeald Coast Foundation

Pelican Plunge 2021 Liability & Waiver Form

I hereby voluntarily elected to participate in The Boardwalk Pelican Plunge.  I understand the nature of the Pelican Plunge event and that I and/or my child am qualified, in good health, and in proper physical condition to participate in such activity.  I acknowledge that if I and/or my child believe event conditions are unsafe, I and/or my child will immediately discontinue participating in the event.

I, therefore, assume all risk associated with my and/or my child’s participation in this event, and I will not hold The Boardwalk, its affiliates, or any sponsors liable for any circumstances related to this event.

I fully understand that this event involves jumping or running into the Gulf of Mexico under January conditions.  Serious bodily injury may be caused by my own actions, actions or inactions of others participating in the event, the conditions in which the event is taking place, or the negligence of others.

I hereby authorize Saltwater Restaurants, Inc., along with its parent, subsidiary, affiliate companies, and related restaurants (“Saltwater”), as well as The Emerald Coast Foundation (herein collectively "Event Organizers"), permission to use my likeness, and if applicable, the below named children’s likeness in photograph(s), or videos, in any and all media and publications, including but not limited to all printed, digital, and online publications. I understand and agree that any videos and photographs using my likeness will become property of Saltwater Restaurants, Inc. and will not be returned.  I acknowledge that since my participation with Saltwater is voluntary, I will receive no financial compensation.

I hereby irrevocably authorize Event Organizers to edit, alter, copy, exhibit, publish or distribute any video or photo for purposes of publicizing current and future The Pelican Plunge events, or for any other lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. Additionally, I waive any right to royalties, or any other compensation arising or related to the use of the photograph, or photographs.

I hereby hold harmless and release and forever discharge Event Organizers, along with all Event Organizers employees, agents, volunteers, and attorneys, from all past, present, and future claims, demands, obligations,  causes of action, damages, costs, attorneys’ fees, and expenses of any kind which I, my heirs, personal representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have or that may hereafter accrue by reason of, or in any way related to this authorization, or Saltwater’s use of the photographs used by Saltwater pursuant to this authorization.

By signing this waiver, I agree, understand, and have read this release and waiver of liability. I assume all risk on behalf of myself and/or my child as it relates to participation in this event. I agree that I freely signed this document without any incentive or reassurance of any nature.  Its purpose is to be a complete and unconditional release of all liability to the greatest extent allowed by law.

I hereby affirm that I fully understand the on behalf of myself and/or my child.

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
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 Email Address

Email*

Confirm Email*
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 Name

First Name*

Last Name*

Phone*
Parent or Guardian Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian 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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