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To be Completed by Participant (if under 18, must be completed by a legal parent/guardian):

1. The undersigned Participant is voluntarily willing to take part in SAMBICA Guest Services Programs and all of its associated activities, unless stated otherwise in writing to SAMBICA. This may include, but is not limited to, Boating and Watersports, the Ropes Course and all of its elements, Archery Tag, Swimming, Archery, Kayaks and Canoes, Stand Up Paddle Boards, Dodgeball, Activities in the TAB, and other indoor/outdoor recreation (hereafter referred to as the SAMBICA Program).

2. The Participant agrees to abide by the rules and regulations governing the SAMBICA Program, and to obey any and all instructions given by the person(s) having supervision and control over the Program.

3. The Participant understands that he/she must report any existing medical, physical, or mental condition before the activity commences, and must choose a level of activity that fits within the safe parameters of his/her condition(s).

4. The Participant releases the corporation of SAMBICA and its directors, officers, employees, agents, and volunteers from and against any and all claims for personal injury, property damage, and any other losses and damages that the Participant may suffer as a result of his/her participation and/or enrollment in SAMBICA Program.

5. The Participant will defend, indemnify, and hold SAMBICA, its directors, officers, employees, agents, and volunteers harmless from any and all third party claims, injuries, damages, losses or suits, including all legal costs and attorney fees, arising out of or in connection with his/her participation in the SAMBICA Program, unless caused by SAMBICA’s sole negligence. In any claim or lawsuit for damages arising from the Participant’s participation in the SAMBICA Program, each party shall pay all its legal costs and attorney’s fees incurred in defending or bringing that claim or lawsuit, including all appeals.

I HAVE READ THIS WAIVER AND RELEASE FROM LIABILITY AND CONSENT. I FULLY UNDERSTAND ITS TERMS AND THAT BY MY SIGNATURE I GIVE UP CERTAIN RIGHTS I MIGHT OTHERWISE HAVE UNDER LAW. I SIGN THIS DOCUMENT FREELY AND VOLUNTARILY, WITHOUT INDUCEMENT.

Date: December 7, 2025

First Participant's Name
First Name*
Middle Name
Last Name*
Phone*
Select Gender
First Participant's Date of Birth*
Date of Birth
First Participant's Information
Does the Participant have any medical conditions (including recent surgery, pregnancy, back or neck injuries, healing fractures, heart condition, etc.) that would limit participation in the Program? (check one)*
No
Yes

If yes, please explain:

List any current medications:

List any allergies:
First Participant's Signature*
Second Participant's Name
First Name*
Middle Name
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Second Participant's Information
Does the Participant have any medical conditions (including recent surgery, pregnancy, back or neck injuries, healing fractures, heart condition, etc.) that would limit participation in the Program? (check one)*
No
Yes

If yes, please explain:

List any current medications:

List any allergies:
Third Participant's Name
First Name*
Middle Name
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Third Participant's Information
Does the Participant have any medical conditions (including recent surgery, pregnancy, back or neck injuries, healing fractures, heart condition, etc.) that would limit participation in the Program? (check one)*
No
Yes

If yes, please explain:

List any current medications:

List any allergies:
Fourth Participant's Name
First Name*
Middle Name
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Fourth Participant's Information
Does the Participant have any medical conditions (including recent surgery, pregnancy, back or neck injuries, healing fractures, heart condition, etc.) that would limit participation in the Program? (check one)*
No
Yes

If yes, please explain:

List any current medications:

List any allergies:
Fifth Participant's Name
First Name*
Middle Name
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Fifth Participant's Information
Does the Participant have any medical conditions (including recent surgery, pregnancy, back or neck injuries, healing fractures, heart condition, etc.) that would limit participation in the Program? (check one)*
No
Yes

If yes, please explain:

List any current medications:

List any allergies:
Sixth Participant's Name
First Name*
Middle Name
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Sixth Participant's Information
Does the Participant have any medical conditions (including recent surgery, pregnancy, back or neck injuries, healing fractures, heart condition, etc.) that would limit participation in the Program? (check one)*
No
Yes

If yes, please explain:

List any current medications:

List any allergies:
Seventh Participant's Name
First Name*
Middle Name
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Seventh Participant's Information
Does the Participant have any medical conditions (including recent surgery, pregnancy, back or neck injuries, healing fractures, heart condition, etc.) that would limit participation in the Program? (check one)*
No
Yes

If yes, please explain:

List any current medications:

List any allergies:
Eighth Participant's Name
First Name*
Middle Name
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Eighth Participant's Information
Does the Participant have any medical conditions (including recent surgery, pregnancy, back or neck injuries, healing fractures, heart condition, etc.) that would limit participation in the Program? (check one)*
No
Yes

If yes, please explain:

List any current medications:

List any allergies:
Ninth Participant's Name
First Name*
Middle Name
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Ninth Participant's Information
Does the Participant have any medical conditions (including recent surgery, pregnancy, back or neck injuries, healing fractures, heart condition, etc.) that would limit participation in the Program? (check one)*
No
Yes

If yes, please explain:

List any current medications:

List any allergies:
Tenth Participant's Name
First Name*
Middle Name
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Tenth Participant's Information
Does the Participant have any medical conditions (including recent surgery, pregnancy, back or neck injuries, healing fractures, heart condition, etc.) that would limit participation in the Program? (check one)*
No
Yes

If yes, please explain:

List any current medications:

List any allergies:
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*
Emergency Contact's Relation to Participant
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*
Select Gender
Parent or Guardian's Date of Birth*
Date of Birth
Parent or Guardian's Information
Does the Participant have any medical conditions (including recent surgery, pregnancy, back or neck injuries, healing fractures, heart condition, etc.) that would limit participation in the Program? (check one)*
No
Yes

If yes, please explain:

List any current medications:

List any allergies:
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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