Loading...

RECREATIONAL ACTIVITY RELEASE OF LIABILITY, WAIVER OF CLAIMS,

EXPRESS ASSUMPTION OF RISK AND INDEMNITY AGREEMENT

 

Please read and be certain you understand the implications of signing. Express assumption of Risk Associated with Recreational Activities at Detroit Ann Arbor KOA:

 

I do hereby affirm and acknowledge that I have been fully informed of the inherent hazards and risks associated with the recreational activity generally described as Slide, Boats, and Banana Bikes, including the rental of equipment and transportation associated therewith in which I am about to engage. Inherent hazard and risks include, but are not limited to:

 

Risk of injury from the activity and equipment utilized is significant including the potential for permanent disability and death.
Possible equipment failure and/or malfunction of my own or other’s equipment.
This activity takes place outdoors and therefore includes risks associated with exposure to elements, excessive heat, hypothermia, impact of the body upon the water, injection of water into my body orifices, encountering objects either natural or man-made, exposure to animals with the attendant risk of kicking, biting. Shying away, running off or otherwise moving in an unanticipated manner causing injury and/or death.
My own negligence and/or the negligence of others, including but not limited to operator error and guide decision making including the misjudging terrain, weather, trails or route location.
Attack or encounter with insects, reptiles, and/or animals.
Accidents or illness occurring in remote places where there are no available medical facilities.
Fatigue, chill, and/or dizziness, which may diminish my/our reaction time and increase the risk of accident.

 

I understand the description of these risks is not complete and that unknown or unanticipated risks may result in injury, illness, or death.

 

Release of liability, Waiver of Claims and Indemnity Agreement.

In consideration for being permitted to participate in the activity(ies) described above and related activities, I hereby agree, acknowledge and appreciate that:

 

I HEREBY RELEASE AND HOLD HARMLESS WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER CAUSED BY NEGLIGENCE OR OTHERWISE, the following named persons or entities, herein referred to as releasees.

 

Detroit Ann Arbor KOA, Land Lease America

 

To release the releasees, their officers, directors, employees, representatives, agents, and volunteers, and vessels from liability and responsibility whatever and for any claims or causes of action that I, my estate, heirs, survivors, executors, or assigns 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. By executing this document, I agree to hold the releasees harmless and indemnify them in conjunction with any injury, disability, death, or loss or damage to person or property that may occur as a result of engaging in the above activities.
By entering into this Agreement, I am not relying on any oral or written representation of statements made by the releasees, other than what is set forth in this Agreement.

 

This release shall be binding to the fullest extent permitted by law. If any provision of this release is found to be unenforceable, the remaining terms shall be enforceable.

 

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, AND FULLY UNDERSTAND ITS TERMS, AND UNDERSTAND THAT I HAVE GIVEN UP LEGAL RIGHTS BY SIGNING IT, AND I SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

 

___________________________________      ___________________________________              _____________

Signature of Adult Participant                                      Name of Adult Participant (please print)                             Date

 

FOR PARTICIPANTS OF MINORITY AGE:  This is to certify that I, as Parent, Guardian, Temporary Guardian with legal responsibility for this participant, do consent and agree not only to his/her release of all Releasees, but also to release and indemnify the Releasees from any and all liabilities incident to his/her involvement in these programs for myself, my heirs, assigns, and next of kin.

 

___________________________________      ___________________________________             _____________

Signature of Parent or adult legal Guardian                 Name of Parent or adult legal Guardian (print)                   Date

If participant is a minor, and by their

Signature, they on my behalf release all

Claims that both they and I have.  

 

1)______________________________________       2)______________________________________            _______________

Name of minors (please print)                                        Name of minor (please print)                                             Date

 

 

2)______________________________________       4)______________________________________             _______________

Name of minors (please print)                                        Name of minor (please print)                                             Date

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 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*

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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!