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COASTAL BEACH CLEANUP

LIABILITY RELEASE, HOLD HARMLESS, AND ASSUMPTION OF RISK AGREEMENT

LIABILITY RELEASE, HOLD HARMLESS, AND ASSUMPTION OF RISK:

 By signing below, I  am willingly and freely participating and volunteering at the Beach Cleanup on the selected date, at the location selected.  I affirm that I am over the age of eighteen (18), am in good health and of sound mind.

 I shall indemnify and hold harmless OKALOOSA COUNTY, its officers and employees, Saltwater Restaurants, Inc., Pier Resort Development, The Gulfarium, and any business, entity, and/or non-profit associated with the cleanup event, along with their parent, subsidiary, affiliate companies, and related restaurants, employees, and any businesses, companies, and governmental agencies (herein collectively referred to as “Event Organizers”) from liabilities, damages, losses, and cost including but not limited to reasonable attorney fees, to the extent caused by my negligence, recklessness, or intentional wrongful conduct while in the performance my volunteer work.   I affirm that I am aware and acknowledge that my volunteer work does not make an employee of Okaloosa County, Florida and I will not be entitled to employee benefits or insurance coverage.

By signing this I hereby affirm that I am aware that any outdoor activity, including beach or coastal cleanups, skin and scuba diving have inherent risks which may result in serious injury or death. I understand outdoor activities, in severe weather involves some risk & that diving with compressed air involves certain inherent risks; including but not limited to decompression sickness, embolism or other hyperbaric/air expansion injury that require treatment in a recompression chamber. I further understand that the open water diving may be conducted at a site that is remote, either by time or distance or both, from such a recompression chamber. I still choose to proceed with such instructional dives despite the possible absence of a recompression chamber in proximity to the dive site.

 I understand and agree that neither my instructor(s), the Event Organizers, the facility or locations through which I conduct a dive with, or receive instruction from, nor PADI Americas, Inc., nor its affiliate and subsidiary corporations, nor any of their respective employees, officers, agents, Event Organizers, contractors or assigns (hereinafter referred to as “Released Parties”) may be held liable or responsible in any way for any injury, death or other damages to me, my family, estate, heirs or assigns that may occur as a result of my participation in this diving program or as a result of the negligence of any party, including the Released Parties, whether passive or active.

In consideration of being allowed to participate in this cleanup event, hereinafter referred to as “Event” I hereby personally assume all risks, whether foreseen or unforeseen, that may befall me while I am a participant in this Event including, but not limited to, confined water and/or open water activities. I further release, exempt and hold harmless said Event and Released Parties from any claim or lawsuit by me, my family, estate, heirs or assigns, arising out of my enrollment and participation in this Event including both claims arising during the Event.

 I also understand that any outdoor activity, including beach and/or coastal cleanups, skin diving and scuba diving are physically strenuous activities and that I will be exerting myself during this Event, and that if I am injured as a result of heart attack, panic, hyperventilation, drowning or any other cause, that I expressly assume the risk of said injuries and that I will not hold the Released Parties responsible for the same.

 I again state that I am of lawful age and legally competent to sign this liability release[PK1] . I understand the terms herein are contractual and not a mere recital, and that I have signed this Agreement of my own free act and with the knowledge that I hereby agree to waive my legal rights. I further agree that if any provision of this Agreement is found to be unenforceable or invalid, that provision shall be severed from this Agreement. The remainder of this Agreement will then be construed as though the unenforceable provision had never been contained herein.

I understand and agree that I am not only giving up my right to sue the Released Parties but also any rights my heirs, assigns, or beneficiaries may have to sue the Released Parties resulting from my death. I further represent I have the authority to do so and that my heirs, assigns, or beneficiaries will be estopped from claiming otherwise because of my representations to the Released Parties.

 Non-Agency Disclosure & Acknowledgement Agreement:

By signing this I understand and agree that PADI Members (“Members”), including Event Organizers and/or any individual PADI Instructors and Divemasters associated with the Event in which I am participating, are licensed to use various PADI Trademarks and to conduct PADI training, but are not agents, employees, or franchisees of PADI Americas, Inc, or its parent, subsidiary and affiliated corporations (“PADI”). I further understand that Member business activities are independent, and are neither owned nor operated by PADI, and that while PADI establishes the standards for PADI diver training programs, it is not responsible for, nor does it have the right to control, the operation of the Members’ business activities and the day-to day conduct of PADI programs and supervision of divers by the Members or their associated staff. I further understand and agree on behalf of myself, my heirs and my estate that in the event of an injury or death during this activity, neither I nor my estate shall seek to hold PADI liable for the actions, inactions or negligence of Event Organizers, and/or the instructors and divemasters associated with the Event.

BY THIS INSTRUMENT AGREE TO EXEMPT AND RELEASE MY INSTRUCTORS, EVENT ORGANIZERS, THE FACILITY THROUGH WHICH I RECEIVE MY INSTRUCTION, AND PADI AMERICAS, INC., AND ALL RELATED ENTITIES AS DEFINED ABOVE, FROM ALL LIABILITY OR RESPONSIBILITY WHATSOEVER FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH HOWEVER CAUSED, INCLUDING, BUT NOT LIMITED TO, THE NEGLIGENCE OF THE RELEASED PARTIES, WHETHER PASSIVE OR ACTIVE.

 [PK1]Check with Risk, but from a liability standpoint I am not sure that the County will want minors to participate in the volunteer work as technically any waiver of indemnity on behalf of a minor will not fully stand up in court. Additionally, there would be requirements related to background checks of the volunteers and employees beyond the usual checks if minors are involved.

First Cleanup Participant's Name

First Name*

Last Name*

Phone*
First Cleanup Participant's Date of Birth*
First Cleanup Participant's Cleanup Date

Beach/Coastal Cleanup Date *
Please check your Cleanup Location: *
The Boardwalk/Newman C. Brackin Wayside Park
Noriega Point
Mattie Kelly Park & Joe's Bayou
Henderson Beach State Park
The Crab Trap Destin/James Lee Park
The Surf Hut
Other

If you selected "Other" as your cleanup location, please indicate where you will clean up, otherwise please put N/A. *
Are you participating in the Pier Dive Cleanup?*
First Cleanup Participant's Signature*
Second Cleanup Participant's Name

First Name*

Last Name*
Second Cleanup Participant's Date of Birth*
Second Cleanup Participant's Cleanup Date

Beach/Coastal Cleanup Date *
Please check your Cleanup Location: *
The Boardwalk/Newman C. Brackin Wayside Park
Noriega Point
Mattie Kelly Park & Joe's Bayou
Henderson Beach State Park
The Crab Trap Destin/James Lee Park
The Surf Hut
Other

If you selected "Other" as your cleanup location, please indicate where you will clean up, otherwise please put N/A. *
Are you participating in the Pier Dive Cleanup?*
Third Cleanup Participant's Name

First Name*

Last Name*
Third Cleanup Participant's Date of Birth*
Third Cleanup Participant's Cleanup Date

Beach/Coastal Cleanup Date *
Please check your Cleanup Location: *
The Boardwalk/Newman C. Brackin Wayside Park
Noriega Point
Mattie Kelly Park & Joe's Bayou
Henderson Beach State Park
The Crab Trap Destin/James Lee Park
The Surf Hut
Other

If you selected "Other" as your cleanup location, please indicate where you will clean up, otherwise please put N/A. *
Are you participating in the Pier Dive Cleanup?*
Fourth Cleanup Participant's Name

First Name*

Last Name*
Fourth Cleanup Participant's Date of Birth*
Fourth Cleanup Participant's Cleanup Date

Beach/Coastal Cleanup Date *
Please check your Cleanup Location: *
The Boardwalk/Newman C. Brackin Wayside Park
Noriega Point
Mattie Kelly Park & Joe's Bayou
Henderson Beach State Park
The Crab Trap Destin/James Lee Park
The Surf Hut
Other

If you selected "Other" as your cleanup location, please indicate where you will clean up, otherwise please put N/A. *
Are you participating in the Pier Dive Cleanup?*
Fifth Cleanup Participant's Name

First Name*

Last Name*
Fifth Cleanup Participant's Date of Birth*
Fifth Cleanup Participant's Cleanup Date

Beach/Coastal Cleanup Date *
Please check your Cleanup Location: *
The Boardwalk/Newman C. Brackin Wayside Park
Noriega Point
Mattie Kelly Park & Joe's Bayou
Henderson Beach State Park
The Crab Trap Destin/James Lee Park
The Surf Hut
Other

If you selected "Other" as your cleanup location, please indicate where you will clean up, otherwise please put N/A. *
Are you participating in the Pier Dive Cleanup?*
Sixth Cleanup Participant's Name

First Name*

Last Name*
Sixth Cleanup Participant's Date of Birth*
Sixth Cleanup Participant's Cleanup Date

Beach/Coastal Cleanup Date *
Please check your Cleanup Location: *
The Boardwalk/Newman C. Brackin Wayside Park
Noriega Point
Mattie Kelly Park & Joe's Bayou
Henderson Beach State Park
The Crab Trap Destin/James Lee Park
The Surf Hut
Other

If you selected "Other" as your cleanup location, please indicate where you will clean up, otherwise please put N/A. *
Are you participating in the Pier Dive Cleanup?*
Seventh Cleanup Participant's Name

First Name*

Last Name*
Seventh Cleanup Participant's Date of Birth*
Seventh Cleanup Participant's Cleanup Date

Beach/Coastal Cleanup Date *
Please check your Cleanup Location: *
The Boardwalk/Newman C. Brackin Wayside Park
Noriega Point
Mattie Kelly Park & Joe's Bayou
Henderson Beach State Park
The Crab Trap Destin/James Lee Park
The Surf Hut
Other

If you selected "Other" as your cleanup location, please indicate where you will clean up, otherwise please put N/A. *
Are you participating in the Pier Dive Cleanup?*
Eighth Cleanup Participant's Name

First Name*

Last Name*
Eighth Cleanup Participant's Date of Birth*
Eighth Cleanup Participant's Cleanup Date

Beach/Coastal Cleanup Date *
Please check your Cleanup Location: *
The Boardwalk/Newman C. Brackin Wayside Park
Noriega Point
Mattie Kelly Park & Joe's Bayou
Henderson Beach State Park
The Crab Trap Destin/James Lee Park
The Surf Hut
Other

If you selected "Other" as your cleanup location, please indicate where you will clean up, otherwise please put N/A. *
Are you participating in the Pier Dive Cleanup?*
Ninth Cleanup Participant's Name

First Name*

Last Name*
Ninth Cleanup Participant's Date of Birth*
Ninth Cleanup Participant's Cleanup Date

Beach/Coastal Cleanup Date *
Please check your Cleanup Location: *
The Boardwalk/Newman C. Brackin Wayside Park
Noriega Point
Mattie Kelly Park & Joe's Bayou
Henderson Beach State Park
The Crab Trap Destin/James Lee Park
The Surf Hut
Other

If you selected "Other" as your cleanup location, please indicate where you will clean up, otherwise please put N/A. *
Are you participating in the Pier Dive Cleanup?*
Tenth Cleanup Participant's Name

First Name*

Last Name*
Tenth Cleanup Participant's Date of Birth*
Tenth Cleanup Participant's Cleanup Date

Beach/Coastal Cleanup Date *
Please check your Cleanup Location: *
The Boardwalk/Newman C. Brackin Wayside Park
Noriega Point
Mattie Kelly Park & Joe's Bayou
Henderson Beach State Park
The Crab Trap Destin/James Lee Park
The Surf Hut
Other

If you selected "Other" as your cleanup location, please indicate where you will clean up, otherwise please put N/A. *
Are you participating in the Pier Dive Cleanup?*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and additional event information.
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*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Cleanup Date

Beach/Coastal Cleanup Date *
Please check your Cleanup Location: *
The Boardwalk/Newman C. Brackin Wayside Park
Noriega Point
Mattie Kelly Park & Joe's Bayou
Henderson Beach State Park
The Crab Trap Destin/James Lee Park
The Surf Hut
Other

If you selected "Other" as your cleanup location, please indicate where you will clean up, otherwise please put N/A. *
Are you participating in the Pier Dive Cleanup?*
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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