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HORNBY ISLAND RESIDENTS' AND RATEPAYERS' ASSOCIATION-RECREATION 

www.hirra.ca/www.hornbyrecreation.ca


RELEASE OF LIABILITY, WAIVER OF CLAIMS

ASSUMPTION OF RISK AND INDEMNITY AGREEMENT

Please note that by signing this agreement, you give up the right to sue for injury or damages, howsoever caused.

To: Hornby Island Residents’ and Ratepayers’ Association- Recreation (“The Company”) and its directors, officers, employees, representatives, and agents (collectively called “The Agents”).

I, hereby sign this agreement on behalf of myself, my personal representatives, heirs and assigns.

 I agree as a precondition to my participation in all events organized by “The Company” and or “The Agents” including, but not limited to ADULT AND YOUTH PROGRAMMING WITH HORNBY ISLAND RESIDENTS’ AND RATEPAYERS’ ASSOCIATION-RECREATION   (Collectively referred to as “The Activities”) and in further consideration of “The Company” allowing me to do so, that I will be strictly bound to terms of this Release of Liability, Waiver of Claims, Assumption of Risk and indemnity Agreement “The Agreement”).

1.       I acknowledge that “The Activities” involved inherent risks and dangers that may cause serious injury and possible death to participants.

2.       I fully understand the risks and dangers associated with my participation in “the Activities” and accept same entirely at my own risk.

3.       I hereby waive any and all claims which I may have against “The Company” and “the Agents” and release “The Company” an “the Agents” from all liability for injury, death, property damage, or any other loss sustained by me as a result of my participation in “The Activities” , due to any cause whatsoever; including negligence, breach of contract, or breach of any statutory or other duty of care by “The Company” and/or “The agents”.

4.       I appreciate that “the Agreement” limits the liability of ‘the Agents” to the same extent as it limits the liability of “The Company”, even thought “The Agents” are not formal parties of the Agreement”.



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
Check to receive information, news, and discounts by e-mail.
A signed copy of this waiver will be sent to the email address you provide.
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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