Today's Date: May 28, 2022 READ AND FILL OUT THIS FORM COMPLETELY AND RETURN PRIOR TO YOUR PROGRAM I agree to voluntarily participate in any way in the programs of Empire Paddle Sports, I recognize that certain inherent risks and dangers exist. I understand that Empire Paddle Sports, its staff, private contractors, and other program participants shall assume no responsibility or liability for me for accident, illness, injury, or loss or damage of all personal property cuased either by negligence or risks inherent to the activities of the program. I knowingly and willingly acknowledge and assume all risks in connection with the activities of the program. I, for myself and on behalf of my heirs, assigns, personal representatives, and next of kin, hereby hold Empire Paddle Sports harmless for any and all liability, action, claims, and damage of every kind. I will comply with the stated terms and conditions for participation. If I observe any unusual significant hazards during my presence or participation, I will remove myself from participation and bring it to the attention of Empire Paddle Sports staff immediately upon occurrence. I hereby grant permission to all of the foregoing to use any photographs, motion pictures, recordings, or any other record of this event for any legitimate purpose. I hereby grant permission to Empire Paddle Sports to place a secure hold on my credit card in the case that I either do not return ALL rented equipment (Charge equal to the full retain price of the unreturned/lost equipment) or if the equipment I do return is damaged and in need of repair ($100 repair charge). AUTHORIZATION OF EMERGENCY MEDICAL CARE I am aware of my general condition and affirm that I am fit to participate in any activities required for participation in this program. I will fully disclose any relevant medical information to Empire Paddle Sports staff and will engage in all prescribed activities except for those noted by me and/or my examining physician. In the event that I am rendered unable to communicate by and emergency or accident, I authorize and request such medical services as may be necessary and further agree to accept financial responsibility for same. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT AND FULLY UNDERSTAND ITS TERMS. MY SIGNATURE ON THE DOCUMENT IS ALSO INTENDED TO BIND MY HEIRS, REPRESENTATIVES, EXECUTORS, OR ADMINISTRATORS. |