Loading...

WAIVER AND RELEASE OF LIABILITY

For and in consideration of Moriches Island MP LLC (the “Organization”) allowing me, the undersigned, to participate in any capacity in an Organization sanctioned, licensed, or approved event or activity (“Event” or “Events”); I, for myself, and on behalf of my spouse, children, heirs and next of kin, and any legal and personal representatives, executors, administrators, successors, and assigns, hereby agree to and make the following contractual representations pursuant to this Agreement (the “Agreement”): 

A. RULES AND REGULATIONS: I hereby agree to abide by the rules, regulations, and policies of the Organization, including any and all COVID-19 related safety measures required by the Organization. These rules and regulations include:

I. Lifejackets will be worn by all participants during sailing lessons. Lifejackets shall be worn by all participants under the age of 18 during charters. Lifejackets shall be worn by all persons whenever directed to do so by any owner, contractor or employee of Moriches Island MP LLC.

II. Compliance to every and all COVID-19 precaution as mandated by the Federal Government, New York State, and Moriches Island MP LLC

III. Alcohol consumption clauses F and G listed below

B. ACKNOWLEDGMENT OF RISK: I understand and acknowledge that boating is dangerous. I knowingly, willingly, and voluntarily acknowledge the inherent risks associated with motor boat chartering and the sport of sailing, and that participation in any Organization involves risks and dangers including, without limitation, the potential for serious bodily injury (including broken bones, head or neck injuries), sickness and disease (including communicable diseases such as COVID-19), trauma, pain & suffering, permanent disability, paralysis and death; wind shear, inclement weather, lightning, variances and extremes of wind, weather and temperature; any sense of balance, physical condition, ability to operate equipment, swim and/or follow directions; collision, capsizing, sinking or other hazard which result in wetness, injury, exposure to the elements, hypothermia, impact of the body upon the water, injection of water into my body orifices, and/or drowning; the presence of insects and marine life forms; equipment failure, operator error, transportation accidents; heat or sun related injuries or illness, including sunburn, sunstroke or dehydration; fatigue, chill, and/or dizziness which may diminish my/our reaction time and increase the risk of an accident; slippery decks when wet loss of or damage to personal property; exposure to extreme conditions and circumstances; accidents involving other participants, event staff, volunteers or spectators; contact or collision with other participants or natural or manmade objects; adverse weather conditions; facilities issues and premises conditions; failure of protective equipment; inadequate safety measures; participants of varying skill levels; situations beyond the immediate control of the Event organizers and competition management; and other undefined, not readily foreseeable and presently unknown risks and dangers (“Risks”).

C. ASSUMPTION OF RISK: I understand that the aforementioned Risks may be caused in whole or in part or result directly or indirectly from the negligence of my own actions or inactions, the actions or inactions of others participating in the Events, or the negligent acts or omissions of the Released Parties defined below, and I hereby voluntarily and knowingly assume all such Risks and responsibility for any damages, liabilities, losses, or expenses that I incur as a result of my participation in any Events. I also agree to be responsible for any injury or damage caused by me or any agents under my direction and control at any Event.

D. RELEASE AND INDEMNITY: In consideration of my participation in any Event, I hereby release from liability and waive any claims against the owner or organizer of the Event, its licensees, competition managers, promoters, sponsors, advertisers, beneficiaries, venue providers, and supporting organizations, together with the officers, directors, employees, volunteers and contractors of them (the “Released Parties” or “Event Organizers”), with respect to any liability, claim(s), demand(s), cause(s) of action, damage(s), loss, or expense (including court costs and reasonable attorney fees) of any kind or nature (“Liability”) which may arise out of, result from, or relate in any way to my participation in the Events, including claims for Liability caused in whole or in part by the negligent acts or omissions of the Released Parties.

Further, I agree to indemnify, defend, and hold harmless the Released Parties and Event Organizers against and from any and all Liability imposed on, incurred by, or asserted against any Released Party or Event Organizer resulting from, arising out of, in connection with, or relating to my breach of this Agreement.

I further understand that after participating in lessons given by the ORGANIZATION, it is solely my responsibility to operate my vessel in a legal and safe manner. I agree to hold the ORGANIZATION harmless in the event that I am involved in a boating event or accident which results in property damage or injury to myself, my family, or a third party relative to which a claim is made against the ORGANIZATION. I agree the ORGANIZATION is not responsible for my conduct while operating a vessel after participating in lessons offered by the ORGANIZATION.

E. COMPLETE AGREEMENT AND SEVERABILITY CLAUSE: This Agreement represents the complete understanding between the parties regarding these issues and no oral representations, statements or inducements have been made apart from this Agreement. If any provision of this Agreement is held to be unlawful, void, or for any reason unenforceable, then that provision shall be deemed severable from this Agreement and shall not affect the validity and enforceability of any remaining provisions.

F. ALCOHOL CONSUMPTION CLAUSE FOR SAILING LESSONS: No alcohol shall be aboard the vessel or consumed during a sailing lesson.

G. ALCOHOL CONSUMPTION CLAUSE FOR CHARTERS: Passengers who are 21 years or older are permitted to bring their own alcohol aboard the vessel for personal consumption during captained charters (sunset cruises, bay cruises, beach days). Beer, wine, champagne and “hard” seltzers are permitted while hard liquor (whiskey, tequila, vodka, gin, etc.) is not permitted. While moderate alcohol consumption is permitted, intoxication is not. If the participant chooses to consume alcohol during a charter it is his or her sole responsibility to do so in moderation. I will hold ORGANIZATION harmless and agree to defend the ORGANIZATION relative to any injury or harm or sustained by me or others as a result of my consumption of any alcohol. The captain of the vessel reserves the right to end the charter at any time if he/she deems the passenger intoxicated or unruly. A verbal warning may or may not be given before returning to the dock immediately. No refunds shall be provided for a charter that ends early due to an intoxicated or unruly passenger. No passenger who has consumed any amount of alcohol shall be permitted to take the helm of the vessel for any reason. No drugs deemed illicit by the federal government are permitted aboard any vessel operated by Moriches Island MP LLC.

H. CAREFREE BOAT CLUB MEMBERS RESPONSIBILITY CLAUSE: I understand and agree to be solely and completely responsible for any and all damage sustained by Carefree vessels and injuries to myself or a third party that occur during a Carefree motor boat lesson with the ORGANIZATION and agree to hold the ORGANIZATION harmless and agree to defend the ORGANIZATION relative to any injury or harm or damage to the vessel sustained during a Carefree motor boat lesson.

I HAVE CAREFULLY READ THIS DOCUMENT IN ITS ENTIRETY, UNDERSTAND ALL OF ITS TERMS AND CONDITIONS, AND KNOW IT CONTAINS AN ASSUMPTION OF RISK, RELEASE, WAIVER FROM LIABILITY, AND INDEMNIFICATION.

By signing below, I (as the participant or as the Parent/Legal Guardian of the minor identified below) hereby accept and agree to the terms and conditions of this Agreement in connection with my (or the minor’s) participation in any Event.

PARTICIPANT INFORMATION & MEDICAL CONSENT

I am aware that sailing and motor boating have inherent dangers and hereby absolve and hold harmless and defend Moriches Island MP LLC and its owner and contractors from any liability for injury of damage not caused by negligence or culpable conduct of Moriches Island MP LLC or its owners, contractors and employees.

In the event of any accident or injury to me, or to the minor named above as the Participant, or in the event of my illness, or any illness of the minor named above as the Participant, while participating in a sailing or motor boat lesson or charter given by Moriches Island MP LLC, if I am unable to consent, or I as parent or guardian am not present:

1. I hereby voluntarily consent to the furnishing to myself, or to the minor named above, of emergency first aid and such other medical care and treatment by any hospital or physician(s) as the hospital or physician(s) deem necessary or advisable or necessary including without limitation, x-ray examination, anesthetic and diagnostic procedures.

2. I authorize any employee, contractor or owner of hold Moriches Island MP LLC to consent to such medical care or treatment.

3. I agree to pay the cost of such medical care or treatment and to indemnify and hold free and harmless of all liability for such cost Moriches Island MP LLC.

4. I give this authorization in advance of any specific diagnosis, treatment or hospital care being required in order to provide authority to render such care as the physicians rendering such care may, in their best judgement, deem advisable.

I hereby authorize any x-ray examination, anesthetic, medical or surgical diagnosis or procedure supervised by any member of the medical staff or of a dentist licensed under the State Education Law and/or Public Health Law of the State and of the staff of any hospital holding a current operating certificate issued by the State Department of Health. This authorization is given in advance of any specific diagnosis, treatment or hospital care being required in order to provide authority to render care, which the aforementioned physician in his best judgment may deem advisable. It is understood that effort shall be made to contact me before rendering treatment to the patient, but any of the above treatment will not be withheld if I cannot be reached.

March 28, 2024



First Participant's Name

First Name*

Last Name*

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

BLOOD TYPE
COVID VACCINE (Y/N)*
No
Yes

The participant or his or her parent/guardian must answer the following as completely and accurately as possible:


Date of last Tdap (Tetanus/Diphtheria/Acellular Pertussis) Shot

Chronic Ailments

Allergies

Current medications/dosages, if any

Other medical information
May we use photos of you and/or your children on our website and social media pages?*
May we send you occasional emails with general and promotional information about Moriches Island Sailing and Marine Services?*
No
Yes
First Participant's Signature*
Second Participant's Name

First Name*

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

BLOOD TYPE
COVID VACCINE (Y/N)*
No
Yes

The participant or his or her parent/guardian must answer the following as completely and accurately as possible:


Date of last Tdap (Tetanus/Diphtheria/Acellular Pertussis) Shot

Chronic Ailments

Allergies

Current medications/dosages, if any

Other medical information
May we use photos of you and/or your children on our website and social media pages?*
May we send you occasional emails with general and promotional information about Moriches Island Sailing and Marine Services?*
No
Yes
Third Participant's Name

First Name*

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

BLOOD TYPE
COVID VACCINE (Y/N)*
No
Yes

The participant or his or her parent/guardian must answer the following as completely and accurately as possible:


Date of last Tdap (Tetanus/Diphtheria/Acellular Pertussis) Shot

Chronic Ailments

Allergies

Current medications/dosages, if any

Other medical information
May we use photos of you and/or your children on our website and social media pages?*
May we send you occasional emails with general and promotional information about Moriches Island Sailing and Marine Services?*
No
Yes
Fourth Participant's Name

First Name*

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

BLOOD TYPE
COVID VACCINE (Y/N)*
No
Yes

The participant or his or her parent/guardian must answer the following as completely and accurately as possible:


Date of last Tdap (Tetanus/Diphtheria/Acellular Pertussis) Shot

Chronic Ailments

Allergies

Current medications/dosages, if any

Other medical information
May we use photos of you and/or your children on our website and social media pages?*
May we send you occasional emails with general and promotional information about Moriches Island Sailing and Marine Services?*
No
Yes
Fifth Participant's Name

First Name*

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

BLOOD TYPE
COVID VACCINE (Y/N)*
No
Yes

The participant or his or her parent/guardian must answer the following as completely and accurately as possible:


Date of last Tdap (Tetanus/Diphtheria/Acellular Pertussis) Shot

Chronic Ailments

Allergies

Current medications/dosages, if any

Other medical information
May we use photos of you and/or your children on our website and social media pages?*
May we send you occasional emails with general and promotional information about Moriches Island Sailing and Marine Services?*
No
Yes
Sixth Participant's Name

First Name*

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

BLOOD TYPE
COVID VACCINE (Y/N)*
No
Yes

The participant or his or her parent/guardian must answer the following as completely and accurately as possible:


Date of last Tdap (Tetanus/Diphtheria/Acellular Pertussis) Shot

Chronic Ailments

Allergies

Current medications/dosages, if any

Other medical information
May we use photos of you and/or your children on our website and social media pages?*
May we send you occasional emails with general and promotional information about Moriches Island Sailing and Marine Services?*
No
Yes
Seventh Participant's Name

First Name*

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

BLOOD TYPE
COVID VACCINE (Y/N)*
No
Yes

The participant or his or her parent/guardian must answer the following as completely and accurately as possible:


Date of last Tdap (Tetanus/Diphtheria/Acellular Pertussis) Shot

Chronic Ailments

Allergies

Current medications/dosages, if any

Other medical information
May we use photos of you and/or your children on our website and social media pages?*
May we send you occasional emails with general and promotional information about Moriches Island Sailing and Marine Services?*
No
Yes
Eighth Participant's Name

First Name*

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

BLOOD TYPE
COVID VACCINE (Y/N)*
No
Yes

The participant or his or her parent/guardian must answer the following as completely and accurately as possible:


Date of last Tdap (Tetanus/Diphtheria/Acellular Pertussis) Shot

Chronic Ailments

Allergies

Current medications/dosages, if any

Other medical information
May we use photos of you and/or your children on our website and social media pages?*
May we send you occasional emails with general and promotional information about Moriches Island Sailing and Marine Services?*
No
Yes
Ninth Participant's Name

First Name*

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

BLOOD TYPE
COVID VACCINE (Y/N)*
No
Yes

The participant or his or her parent/guardian must answer the following as completely and accurately as possible:


Date of last Tdap (Tetanus/Diphtheria/Acellular Pertussis) Shot

Chronic Ailments

Allergies

Current medications/dosages, if any

Other medical information
May we use photos of you and/or your children on our website and social media pages?*
May we send you occasional emails with general and promotional information about Moriches Island Sailing and Marine Services?*
No
Yes
Tenth Participant's Name

First Name*

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

BLOOD TYPE
COVID VACCINE (Y/N)*
No
Yes

The participant or his or her parent/guardian must answer the following as completely and accurately as possible:


Date of last Tdap (Tetanus/Diphtheria/Acellular Pertussis) Shot

Chronic Ailments

Allergies

Current medications/dosages, if any

Other medical information
May we use photos of you and/or your children on our website and social media pages?*
May we send you occasional emails with general and promotional information about Moriches Island Sailing and Marine Services?*
No
Yes
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.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Health Insurance

Insurance Carrier *

Insurance Policy Number *
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
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*

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

BLOOD TYPE
COVID VACCINE (Y/N)*
No
Yes

The participant or his or her parent/guardian must answer the following as completely and accurately as possible:


Date of last Tdap (Tetanus/Diphtheria/Acellular Pertussis) Shot

Chronic Ailments

Allergies

Current medications/dosages, if any

Other medical information
May we use photos of you and/or your children on our website and social media pages?*
May we send you occasional emails with general and promotional information about Moriches Island Sailing and Marine Services?*
No
Yes
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!