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Alabama Coastal Amusements, LLC

Coastal Segway Adventures

SEGWAY ACCIDENT WAIVER, RELEASE AND INDEMNITY FORM (SAWRI)

 

By signing this document, you are certifying that you have read and understand this Segway Accident Waiver, Release and Indemnity Form, hereinafter referred to a SAWRI, and accept its terms. All participants under the age of 19 must have this SAWRI form signed by a parent or legal guardian. Minors under the age of 12 are not permitted to participate in a Coastal Segway Adventures tour and may not operate our Segway equipment. Further, a parent must be on the same guided tour that includes the minors under the age of 16 in the group. Any parent or legal guardian signing this SAWRI is hereby consenting to all of the Indemnity provisions.

I have hereby been advised by a Coastal Segway Adventures tour Trainer of safety precaution and trained to my satisfaction before using the Segway Human Transporter ( “Segway”). I hereby certify that I am physically able, and have not been advised against, participation in such an activity. I have been offered a helmet to wear while riding, free of charge. I agree to wear the helmet at all time while operation or standing on a Segway.

I hereby acknowledge that participation in a demonstration or tour using a Segway carries with it certain inherent risks and the potential for injury, which may be minor or serious injury that cannot be completely eliminated. The risks include, but are not limited to those caused by terrain, facilities, condition of the rider, equipment, traffic, wildlife or actions of other people, including but not limited to, other riders, pedestrians, and bystanders. I understand that the injuries can range from minor to serious and even death. Being aware of these risks, I hereby assume all risks associated with the use of the Segway during demonstration, tour and all related events.

I understand that if I misuse or fall off the Segway on if an event occurs caused by any of the potential hazards mentioned herein or other not specifically listed including, but not limited to, what are commonly called “Acts of God,” I am assuming complete and total responsibility for any injuries I sustain or damage to my personal property.

As an independent rider, I understand and agree that I will be completely responsible for controlling my Segway safely. I accept complete financial responsibility for any damage or loss to any Segway that I ride or damage during the demonstration or tour. I realize that I may incur liability from my negligence or carelessness and I will accept the full responsibility for my actions, my well-being, and any damages that I may cause. On behalf of myself, my executors, administrators, heirs, personal representatives, next of kin, successors, and assigns, I do hereby waive release, and forever discharge (A) Coastal Segway Adventures, (B) the owners of any property on which any part of the demonstration or tour is conducted, as well as any of their property managers, lessees, or licensees, and (C) any of the foregoing persons, or entities, officers, directors, owners, employees, representatives, successors, assigns, executors, administrators, heirs, personal representatives, and the next of kin (collectively, “Releases”) from any and all claims, demands, loss or causes of action of any nature whatsoever arising out of or relating to my participation in the demonstration, tour, or use of a Segway. This release applies regardless of the legal theory on which a claim may be based (Including, but not limited to, the negligence of Releasees.) This release includes, but is not limited to claims for personal injury, disability, death, and personal property damage or loss. On behalf of myself and the others for whom I have made the foregoing release, I further promise and covenant never to institute, or to assist any other person in instituting, any type of legal proceeding, in law or in equity, seeking to recover for any of the claims released herein.

I further agree to assume all responsibility for my personal property during the tour and demonstration, and that Releasees shall have no liability for the loss of damage to my personal property. I further consent to Coastal Segway Adventures taking photographs, videotapes, or other images of me during the demonstration and tour and using such images in its advertising, instructional, and promotional materials in any medium without any compensation to me and without my further consent.

I hereby indemnify and hold harmless each Releasee from any and all claims, demands, and loss of any type, including, without limitation, attorney’s fees, litigation expenses, and costs of litigation, resulting from or relating to my participation in the demonstration and tour, my use of a Segway, or from any person or entity asserting any of the claims released herein against any Releasee. This indemnity shall not apply to claims against a particular Releasee that results from the sole negligence of that Releasee. If I am a parent or guardian giving permission on behalf of a minor under the age of 19, I independently assume this indemnity obligation with respect to any claims arising out of the minor’s participation in the demonstration and tour.

This SAWRI shall be construed broadly to provide a release, waiver and indemnity to the maximum extent permissible under applicable law. I further agree that any legal actions relating to my participation in the tour and demonstration or relating to the SAWRI shall be brought solely and exclusively in the Alabama courts located in Baldwin County, Alabama, or the United States District Court for the Southern District of Alabama.

Today's Date: May 1, 2024

Segway Reasonable Replacement Costs:

Complete loss, theft, or destruction of Segway $6500

If damage occurs but total loss cannot be determined at that time, a $2500 security deposit will be charged until a confirmation of the cost of damage can be determined. At that time the cost of damages will be charged and the remaining balance of the security deposit will be refunded.

Please agree and check the following: *
I accept that I am responsible for the Segway and agree to the replacement cost listed.
First Participant's Name

First Name*

Last Name*

Phone*
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*

Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 19 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.




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 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.


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