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I, the undersigned(s), agree to the following Waiver, Releases, and Compliance at Honesdale/Pocono KOA Holiday (Hereby HP KOA) at 50 Countryside Lane, Honesdale, PA 18431. I understand that I am of the age to sign and am freely signing this Waiver.

 

I understand the risk of injury that exists while participating in CAMPING and All Activities/Amenities on this campground (hereinafter the ‘Camping’); and in consideration of my desire to participate is said Camping participate in same;

 

 In consideration of Honesdale/Pocono KOA, renting me any RV Site, Tent Site, Cabin (deluxe), Amenities, Equipment, or Usage, I specifically release and forever discharge HPKOA and its officers, agents, and employees from all liability during Camping or claims for injury, illness, death, or loss of reputation or damage to property, which I may suffer while renting/participating said RV Site/Tent Site/ Cabin (deluxe), campground/amenity/equipment/usage. This discharge specifically includes but is not limited to, liability or claims for injury, illness, and death or damaged, including but not limited to, COVID-19 or any other disease/sickness. It is my intent by the Waiver and Release Agreement to release HPKOA and hold harmless from all liability for any such property loss or damage, personal injury, or loss of life, negative reputation on USurveyed posting/listing of my (family) name, whether caused by the negligence of HPKOA or my breach of campground rules and/or whether based upon breach of contract, breach of warranty, or any other legal theory. I understand that I am giving HPKOA the right to use my name on the USurveyed.com website for my and my family/friend's behavior while at the property of HPKOA during the above dates.

  • I understand that I will not participate in any Camping if I am under the influence of drugs or alcohol. 
  • I agree that I will not use drones while Camping on the property as I do not have Photo Permission. 
  • I Agree that my and my underage children, listed below, photos may be taken and used for Social Media and Print Media uses by Honesdale/Pocono KOA Holiday & its affiliates. 
  • I have read and understand the above Waiver for me and my undersigned. 

I understand there will be no refunds after checking in and I agree to all Sites – RV, Tent, Cabins/Deluxe Cabin fees/payments and deposits, as well as my visitor(s), visitor fees, and any store purchases while Camping.


Gate Key – I agree if I do not return my site Gate Key, my credit card will be charged $35 after my departure. My Gate key will be revoked if I give/use it for anyone not listed on my registration.



 






First Participant's Name

First Name*

Last Name*
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
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*
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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.


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*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
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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