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Kokopelli Surf Camp Lesson/Tour/Rental Waiver



ACKNOWLEDGMENT OF RISKS

I understand that surfing, paddleboarding, kayaking, and related ocean activities carry an inherent risk of bodily injury, including, in extreme cases, loss of life from the surf/swimming environment, wave action, currents, surfing equipment, and but not limited, to sea pests. I agree to indemnify, defend, hold harmless and release from all liability, the city and county governments concerned, the State of South Carolina, the U.S. Government, and Kokopelli Surf Camp LLC, its owners, employees, equipment, sponsors, and hotel partners.

LIABILITY AND INDEMNITY AGREEMENT

In consideration of my/my child’s participation in the beach activities mentioned above,

I,( refer to name signed below ) understand and AGREE AS FOLLOWS:

I assume full responsibility for risks of bodily, mental distress, death or property damage due to the active or passive acts or omissions of Kokopelli Surf Camp agents, volunteers, employees, officers, and board members arising from my/my child’s participation with any of the activities.

I / my child am/is in good health and I’m/is an able swimmer.

Additionally, I understand that:

Photos taken may be used for promotional purposes.

Any rental equipment damaged or lost will be charged to me at full price of replacement or repair.

Beach closures due to water hazards or severe weather conditions may affect my/my child’s available activity time.

Kokopelli Surf Camp Company has the right to deem it necessary to reschedule or cancel lessons or rentals due to weather conditions or lack thereof.

The staff of Kokopelli Surf Camp and state safety officials may act as first responders in the capacity of emergency medical examination and/or treatment.

I HAVE READ AND UNDERSTAND this “Acknowledgement of Risks and Release, Waiver of Liability and Indemnity Agreement” and have signed this Acknowledgement of Risk and Release, Waiver of Liability and Indemnity voluntarily and agree that no oral representation, agreements, or inducements, apart from the foregoing written agreement have been made.


BY AFFIXING MY SIGNATURE BELOW, I HEREBY STATE THAT I HAVE READ AND UNDERSTAND THE FOLOWING: I hereby for myself, my child, my heirs, executors, administrators and assigns, waive, release and discharge the City of North Myrtle Beach, its employees, elected officials, agents and assigns from any and all claims, losses, causes of action, including but not limited to, death, personal injury, illness (ex. Communicable diseases such as MRSA, influenza and COVID-19) and/or property damage, whether or not caused by the negligence of the releases, arising out of my participation in any program or use of the facilities or equipment approved by the City of North Myrtle Beach. I am aware that there are risks associated with participation in programs and/or with the use of the facilities and equipment and I ASSUME ALL RISKS for any injury, including death, or property damage, including those injuries arising from the negligence of the releases, while on the premises, using equipment and/or participating in any program approved by the City of North Myrtle Beach.

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email*

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

First Name*

Last Name*

Emergency Contact's Phone Number*
Other Adults and Minors in your group accepting conditons of waiver. List below.

First and Last names of other participants in your group
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*

Middle Name

Last Name*

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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