Loading...

***READ RELEASE BEFORE SIGNING***

Anyone born on or after January 1, 1988 who operates a vessel powered by 10 horsepower or more must have in his/her possession a photo ID and a boating safety education identification card issued by the Florida Fish and Wildlife Conservation Commission.

*Please note that if you are renting a Tube or any other towables, the following will apply to you:

Anchorage Yacht Basin, Inc.
96 E. Eau Gallie Causeway
Melbourne, FL 32937
(321) 425-2500

ASSUMPTION OF RISK, RELEASE OF LIABILITY & WAIVER OF CLAIMS AGREEMENT In consideration of being allowed to use the facilities and participate in the operation of Vessels, Waterskiing, Wakeboarding, Tubing and Related Activities (collectively the Activities) provided by Anchorage Yacht Basin Inc. (the Host), the Participant [or his/her parent(s) or legal guardian(s)] do hereby agree, to the fullest extent permitted by law, as follows:

TO WAIVE ALL CLAIMS that they have or may have against the Host, its owners, affiliates, employees, and/or agents arising out of the inherent risks of participating in the Activities;

TO ASSUME ALL RISKS INHERENT IN PARTICIPATING IN THE ACTIVITIES and using the Equipment, even those caused by the negligent acts or conduct of the Host, its owners, affiliates, operators, employees, agents, and/or officers. The Participant [or his/her parent(s) or legal guardian(s)] understand(s) that there are inherent risks of participating in the Activities and using the Equipment, which may be both foreseen and unforeseen and include serious physical injury and death; 

TO RELEASE the Host, its owners, affiliates, employees, and/or agents, from all liability for any loss, damage, injury, or expense forming the basis for a claim and/or cause of action that the Participant [or his/her parent(s) or legal guardian(s)] may suffer, arising out of the inherent risks of participation in the Activities.

Personal Responsibility

The Participant and his/her parent(s) or legal guardian(s) certify that Participant has no physical or mental condition that precludes him/her from participating in the Activities and that he/she is not participating against medical advice.

The Participant and his/her parent(s) or legal guardian(s) understand that Participants participation in the Activities is voluntary and further understand that they have the opportunity to inspect the Hosts equipment and facilities before any participation.

The Participant and his/her parent(s) or legal guardian(s) understand that Participant is obligated to follow the rules of the Activities and that he/she can minimize his/her risk of injury by doing so and through the exercise of common sense and by being aware of his/her surroundings.

If, while participating in the Activities, the Participant and/or his/her parent(s) or legal guardian(s) observe any unusual hazard or condition, which they believe jeopardizes Participants personal safety or that of others, Participant and/or his/her parent(s) or legal guardian(s) will remove Participant from participation in the Activities and immediately bring said hazard or condition to the attention of the Host.

To the extent that any portion of this Agreement is deemed to be invalid under the law of the applicable jurisdiction, the remaining portions of the Agreement shall remain binding and available for use by the Host and its counsel in any proceeding.

I/WE HAVE READ THE ABOVE WAIVER AND RELEASE, UNDERSTAND THAT I/WE HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, HAVE NOT CHANGED IT ORALLY, AND SIGN IT VOLUNTARILY.

BY SIGNING THIS AGREEMENT, YOU AND YOUR MINOR CHILDREN ARE GIVING UP YOUR RIGHTS TO SUE THE HOST, ITS OWNERS, AFFILIATES, EMPLOYEES, AND/OR AGENTS FOR ANY REASON WHATSOEVER  FOR ANYTHING OCCURRING UPON THESE PREMISES OR DURING OUR EVENTS FOREVER.

I UNDERSTAND I EXPRESSLY ASSUME ALL RISK INHERENT TO THE USE OF THE FACILITIES, AS WELL AS PARTICIPATING IN AND OBSERVING ANY WATERSPORT, INCLUDING BUT NOT LIMITED TO THE USE OF BOATS, AND ANY AND ALL EQUIPMENT.

Please read and be certain you understand the implications of signing. Express Assumption of Risk Associated with use of Personal Watercraft, Waterskiing, Wakeboarding, Tubing and Related Activities.

By signing this waiver I hereby affirm and acknowledge that I have been fully informed of the inherent hazards and risks associated with the operation of Personal Watercraft, Waterskiing, Wakeboarding, Tubing and activities, transportation to and from the vessel and related watersports activities to which I am about to engage, including but not limited to:

Changing water flow, tides, currents, wave action, and ship's wakes;

Collision with any of the following:

a) Other participants, b) the watercraft, c) other watercraft, d) man made or natural objects, e) shuttle boat;

Wind shear, inclement weather, lightning, variances and extremes of wind, weather and temperature;

My sense of balance, physical condition, ability to operate equipment, swim and / or follow directions;

Collision, capsizing, sinking, or other hazard that may result in wetness, injury, exposure to the elements, hypothermia, impact of the body upon the water, injection of water into my body orifices, and/or drowning;

The presence of insects, bacteria and marine life forms;

Equipment failure or operator error;

Heat or sun related injuries or illnesses, including sunburn, sun stroke or dehydration;

Fatigue, chill and / or reaction time and increased risk of an accident.

If any provision in this agreement is invalid or unenforceable under applicable law, the remaining provisions will continue and in full force and effect.

 

RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY AGREEMENT

In consideration of being allowed to participate in the above described Watersports, Transportation, and Water Ski / Wake Board/ Tubing activities, as well as the use of any of the facilities, boats, personal watercraft, specifically, including transportation and the use of the equipment of the below listed releasees, I hereby agree as follows:

1) To waive and release any and all claims based upon negligence, active or passive, with the exception of intentional, wanton, or willful misconduct that I may have in the future against all of the following named persons or entities herein referred to as releasees:

Anchorage Yacht Basin Inc. Owner (Company and/or Individuals)

Anchorage Yacht Basin, LLC. (Company and or Individuals)

2) To release the releasees, their officers, directors, employees, representatives, agents, and volunteers, and vessels from liability and responsibility whatsoever and for any claims or causes of action that I, my estate, heirs, executors, or assignees may have for personal injury, property damage, or wrongful death arising from the above activities whether caused by active or passive negligence of the releasees or otherwise, with the exception of gross negligence. By executing this document, I agree to hold the releasees harmless and indemnify them in conjunction with any injury or loss of life that may occur as a result of engaging in the above activities.

3) By entering into this Agreement, I am not relying on any oral or written representation or statements made by the releasees, other than what is set forth in this Agreement.

I hereby declare that I am of legal age and am competent to sign this Agreement or, if not, that my parent or legal guardian shall sign on my behalf and that my parent or legal guardian is in complete understanding and concurrence with this Agreement.

DECLARATION OF FITNESS TO PARTICIPATE IN WATERSPORTS ACTIVITIES

I hereby declare I am physically fit. I do not, and have not, suffered from any of the following conditions, which I understand may lead to a dangerous situation with regard to other persons or myself during Watersports activities:

Epilepsy, fits, severe head injury, recurrent blackouts or giddiness, disease of the brain or nervous system, high blood pressure, lung or heart disease, recurrent weakness or dislocation of any limb, diabetes, mental illness, drug or alcohol addiction, recent back injury, arthritis or severe joint sprains, chronic bronchitis, asthma, rheumatic fever, thyroid adrenal or other glandular disorder, recent blood donation or any condition that requires the regular use of drugs. I hereby declare that I have no physical or mental condition that should preclude me from participating in my chosen activity, that I am not participating against medical advice or treatment, and that I have not been diagnosed by a registered doctor as having a terminal illness. Even if I have a health condition as stated above of which I am unaware, by signing this form I still choose to participate in the activity of Personal Watercraft, Waterskiing, Wakeboarding, Tubing and Related Activities, and agree to waive all responsibilities to all above mentioned parties concerning any consequences that would result from my actions. I further declare that in the event that I feel ill or unwell, have any physical complaints whatsoever or if an injury is sustained of any kind during the course of the Activities, I will notify the Host immediately and before leaving the premises.

I have read all parts of these declarations on both the front and back side of this form, understand them, and I agree to be bound by them.

Important: If you cannot sign the above declaration because of any of the above conditions, you must notify the Host immediately before you leave shore or board any Watersports Vessel.

Today's Date: June 27, 2022

First Participant's Name

First Name*

Last Name*
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.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
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*
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!