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Daily Passenger Boat Service Unaccompanied Minor Permission Form

RELEASE OF LIABILITY

I acknowledge that this activity entails inherent risks that could result in physical or emotional injury, paralysis or death, as well as damage to or loss of property. I hereby release San Juan Safaris and its staff and representatives, from liability for such loss or injury as the result of this trip, TO THE EXTENT ALLOWED BY LAW. I certify that my child has no known medical or physical conditions which could interfere with his/her safety in this activity. In the event that it becomes necessary for San Juan Safaris to obtain emergency care for my child, I acknowledge that neither the company nor the individual staff member is responsible for the expense incurred as the result of the accident, injury, illness, or other unforeseen circumstance. I authorize qualified emergency professionals to examine, and in the event of injury or serious illness, administer emergency care to the above named.

All reasonable effort has been made by San Juan Safaris to fully disclose the nature of this trip to me. I have had the opportunity to ask any questions regarding this trip. In consideration of the services furnished to me, my legal representatives and I release and forever discharge San Jaun Safaris, its owners, officers, directors, agents, contractors, and employees from and against all liability which may arise from my child's participation on this trip, including any claim for property loss, damage, injury, or death that they may suffer, or any claims of negligence or omission.

I further agree to indemnify and hold harmless SJIO and other participants of the trip against any sum I may be subjected to pay in consequence of any claim or demand made against me during my child's participation on this trip, unless the party is liable for such claim or demand.

This agreement is intended to be interpreted as broadly as permissible under Washington law and if any portion of this agreement is held invalid, it is agreed that all other parts will continue in full legal force and effect. This agreement will be interpreted, construed and governed by and under Washington State law, and any claim or controversy arising out of or relating to this agreement will be settled by binding arbitration in San Juan County, Washington. Exclusive venue and jurisdiction over the parties and the subject matter to this agreement will be in the San Juan District Court of Washington in San Juan County for commencing the arbitration proceedings and enforcing the arbitration award.  


First Parent/Guardian's Name

First Name*

Last Name*

Phone*
First Parent/Guardian's Date of Birth*
First Parent/Guardian's Signature*
Second Parent/Guardian's Name

First Name*

Last Name*
Second Parent/Guardian's Date of Birth*
Third Parent/Guardian's Name

First Name*

Last Name*
Third Parent/Guardian's Date of Birth*
Fourth Parent/Guardian's Name

First Name*

Last Name*
Fourth Parent/Guardian's Date of Birth*
Fifth Parent/Guardian's Name

First Name*

Last Name*
Fifth Parent/Guardian's Date of Birth*
Sixth Parent/Guardian's Name

First Name*

Last Name*
Sixth Parent/Guardian's Date of Birth*
Seventh Parent/Guardian's Name

First Name*

Last Name*
Seventh Parent/Guardian's Date of Birth*
Eighth Parent/Guardian's Name

First Name*

Last Name*
Eighth Parent/Guardian's Date of Birth*
Ninth Parent/Guardian's Name

First Name*

Last Name*
Ninth Parent/Guardian's Date of Birth*
Tenth Parent/Guardian's Name

First Name*

Last Name*
Tenth Parent/Guardian'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*

Relationship*

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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