Loading...

Salt Pump Climbing Portsmouth, LLC

199 Constitution Avenue

Portsmouth, NH 03801

(603) 368-1019

info@saltpumpclimbing.com

Van Rider to Salt Pump Portsmouth, LLC’s, Assumption of Risk, Release of Liability, and Indemnification Agreement (the “Rider”) 

Please read this document carefully. I have agreed to Salt Pump Portsmouth, LLC’s (“Salt Pump”), Assumption of Risk, Release of Liability, and Indemnification Agreement (the “Agreement”) in consideration of the services provided by Salt Pump and further agree to the following:

In consideration for the transportation services to be provided by Salt Pump, I recognize and acknowledge that Salt Pump is neither a common carrier nor in the business of providing transportation services to the public. I further recognize and acknowledge that there are certain risks of injury, damage or loss in receiving such transportation services, and I voluntarily agree to assume the full risk of any injuries, damages or loss, regardless of severity, that I may sustain as a result of participating in any and all activities connected with or associated with receiving such transportation services. I do hereby fully release and forever discharge Salt Pump, including its respective officers, directors, instructors, employees, agents, members, and all others associated with Salt Pump from any and all claims for injuries, damages or loss that I may have or which may accrue to me against Salt Pump arising out of, connected with, or in any way associated with such transportation services. I further agree to defend and indemnify Salt Pump, its officers, directors, instructors, employees, agents, and all others associated with Salt Pump from and against all allegations, claims, actions, suits, demands, damages, liabilities, obligations, losses, settlements, judgments, costs and expenses (including without limitation attorneys’ fees and costs) which arise out of, relate to, or result from any act or omission of Salt Pump, including with respect to Salt Pump’s transportation services. If any part of this Rider is found by a court or other appropriate authority to be invalid or conflict with the remainder of this Rider, the remainder of the Agreement nevertheless will be in full force and effect. Any modifications of this Rider must be approved by Salt Pump in writing. 


I HAVE READ THIS RIDER (ALONG WITH THE AGREEMENT) AND UNDERSTAND AND VOLUNTARILY AGREE TO ITS TERMS, WHICH SHALL BE BINDING UPON MYSELF, MY HEIRS, ESTATE, EXECUTORS, AND ADMINISTRATORS. I AM EIGHTEEN YEARS OF AGE OR OLDER. 


I hereby execute this Release for myself and for my heirs, beneficiaries, personal representatives, executors, administrators, successors and assigns.




First Participant's Name
First Name*
Middle Name
Last Name*
Phone*
First Participant's Date of Birth*
Date of Birth
First Participant's Signature*
Second Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Third Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Fourth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Fifth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Sixth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Seventh Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Eighth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Ninth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Tenth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Parent or Guardian's Email Address
Email*
Confirm Email*
Check to receive information, news, and discounts by e-mail.

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.

I represent that I am the parent or legal guardian of the above individual(s) and hereby consent to their use of Salt Pump’s transportation services. In consideration of Salt Pump allowing the below-named participant(s) to use Salt Pump’s transportation services, I agree to be bound by the terms and conditions of this Rider. On behalf of myself and my spouse or domestic partner, I hereby KNOWINGLY, INTENTIONALLY AND VOLUNTARILY WAIVE AND RELEASE, indemnify, hold harmless and forever discharge Salt Pump, its officers, directors, instructors, employees, agents, and all others associated with Salt Pump of and from any and all claims, demands, debts, contracts, expenses, causes of action, lawsuits, damage and liabilities, of every kind and nature, whether known or unknown, in law or equity, that said minor(s) ever had or may have, arising from or in any way related to such minor(s)’s use of Salt Pump’s transportation services. I further agree to defend and indemnify Salt Pump, its officers, directors, instructors, employees, agents, and all others associated with Salt Pump from and against all allegations, claims, actions, suits, demands, damages, liabilities, obligations, losses, settlements, judgments, costs and expenses (including without limitation attorneys’ fees and costs), including those brought by or on behalf of, or otherwise caused by the above-named participant(s), which arise out of, relate to, or result from any act or omission of Salt Pump, including with respect to Salt Pump’s transportation services.



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*
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! and  Rock Gym Pro