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WESTPORT PADDLE CLUB
471 Riverside Ave, Westport CT 06880
(203) 998-1519

2021 PARTICIPANT RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT

WESTPORT PADDLE CLUB, LLC  is not responsible for your personal possessions. We recommend you leave them in your car and bring only what you are taking out with you.

**READ BEFORE SIGNING***

In consideration of being allowed to participate in any way in the program, related events and activities (the “Activities”) offered by Westport Paddle Club, LLC. , I the undersigned, acknowledge and agree that:

1. The Activities are inherently dangerous, and the risk of injury from the Activities is significant, including the potential for permanent injury, paralysis and death. I KNOWINGLY & FREEY ASSUME ALL SUCH RISKS, both known and unknown, and assume full responsibility for my participation.

2 If I observe any unusual condition or situation that appears to be hazardous during my presence or participation, I will remove myself from participation and bring same to the attention of the nearest “WPC” personnel,  immediately.   

3. I consent to the use of any pictures or video taken of me or provided by me for social media, promotion, television, websites or any other use, and expressly waive any right of privacy, compensation, copyright or other ownership.  

4. I, for myself and on behalf of my heirs, and, personal representatives, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS Westport Paddle Club LLC, and their respective owners, officers, managers, agents and/or employees, as well as other participants in the Activities and Westport Paddle Club, LLC  sponsors, advertisers, (collectively, the “RELEASEES”), from any and all claims, demands, losses, and liability arising out of or related to any INJURY, ACCIDENT OR DEATH I may suffer arising from or in connection with my participate in any Activities, as well as or loss or damage to any other person or to property, to the fullest extent permitted by law.

5. EQUIPMENT RENTAL

In consideration of the agreement herein, LESSOR does lease to the undersigned (hereafter referred to as the LESSEE) the equipment described to them. LESSEE agrees said equipment will not be occupied by a greater number of persons than discussed. In the event that the equipment is not returned at time specified herein, said LESSEE agrees to pay OVERTIME at the rate posted.

  • THE LESSEE CERTIFIES THAT HE/SHE HAS EXAMINED THE EQUIPMENT AND FINDS IT ACCEPTABLE AND SUITABLE FOR THE PURPOSE FOR WHICH IT IS LEASED. THAT HE/SHE WILL OPERATE THE EQUIPMENT IN ACCORDANCE WITH ALL SAFETY RULES AND REGULATIONS AS POSTED OR ON THE EQUIPMENT, AND FURTHER CERTIFIES THAT HE/SHE HAS READ AND UNDERSTANDS SAID RULES AND REGULATIONS.  
  • LESSEE AGREES TO REPORT ANY ACCIDENT, MALFUNCTION OR BREAKDOWN OF RENTAL EQUIPMENT TO LESSOR IMMEDIATELY. 

 

This is to certify that I (We), the LESSEE(S) am/are experienced and capable in all aspects of handling and operation of equipment such as that rented above.

 

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY.

Today's Date: June 13, 2021

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*
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*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
This is to certify that I, as parent/guardian with legal responsibility for this participant, do hereby grant the above release on behalf of said minor and on my own behalf.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*

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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