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Liability Waiver Form – Shoreline Cleanup

VOLUNTEER REGISTRATION AND RELEASE OF LIABILITY - STEWARDSHIP ACTIVITIES FOR ANACORTES DIVING & SUPPLY

Description of Volunteer Stewardship Activities:

Volunteers will participate in a shoreline clean-up for a maximum of 2 hours.

Activities will include picking up and hauling man-made debris found along the shoreline and sorting items for proper removal. Activities will take place outdoors and involve walking over uneven terrain including through sand or in the water. Biting or stinging insects may be present. No swimming is permitted, but participants may choose to wade in the water at their own risk. Volunteers should not pick up any debris that may cause them harm, such as glass or needles. Shoes must be worn at all times. Restrooms are available on-site.

In consideration of my participation as a volunteer member of a work crew of Anacortes Diving & Supply, Inc. performing stewardship activities, I agree as follows:

I Agree
I will follow the instructions of the event leader.

I Agree
I understand the proper operation of the equipment I am to use. I understand that my participation in this work may involve sustained strenuous physical activity.

I Agree
I am in good health and I am aware of no physical problem or condition which will limit or interfere with my ability to participate as a member of the crew under either predicted or emergency conditions. I also understand that medical attention may not be readily available.

I Agree
I understand that the stewardship activities may involve dangerous activities or situations. I agree that I am participating at my own risk, and acknowledge that Anacortes Diving & Supply has made no warranty or representation, express or implied, regarding the safety of conducting this work.

I Agree
I understand that I am not an employee of Anacortes Diving & Supply and that I will receive no compensation or other employment-related benefits.

I Agree
On behalf of myself, my heirs, successors and assigns, I hereby forever release, indemnify and hold Anacortes Diving & Supply, Inc, its officers, directors, employees and agents, harmless from and against any and all claims, liabilities, losses, damages, costs and expenses arising from or in any way related to, my service as a volunteer. I intend this release to be effective, regardless of whether the claim of liability is asserted in negligence, strict liability in tort, or other theory of recovery.

I Agree
WATER RELATED ACTIVITIES: If I (or we) am/are in or near a body of water or on watercraft in connection with the Activity, I also understand the risks related to waterbodies and watercraft, including but not limited to risks related to swimming proficiency, water movement, (including risks related to exertion), collisions, water temperature (including hypothermia), tides, exposure, watercraft operation, equipment failure, and rescue efforts.

I Agree
MEDIA AUTHORIZATION: I grant Anacortes Diving & Supply permission to take photographs and video recordings of me and to display, publish or otherwise use any photographs, video recording, or any other media associated with the activity, including any media which contains my image or likeness, for Anacortes Diving & Supply's purposes. I also consent to the use of my name in connection with such images. I release, indemnify and hold harmless Anacortes Diving & Supply and its officers, directors, agents and employees from any and all claims which may result at any time by reason of the use of my image and name, including, without limitation, claims of privacy. My heirs, executors, administrators and assigns shall be bound by this consent and release. 

I Agree
By signing below, I acknowledge that I have thoroughly read and understand this form and that the statements I have made in it are all true, and that I am at least 18 years of age or, if I am not 18 years of age, the signature and consent of my parent or legal guardian is included below. 

First Participant's Name
First Name*
Last Name*
Phone*
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
First Participant's Signature*
Second Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Third Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Fourth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Fifth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Sixth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Seventh Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Eighth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Ninth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Tenth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Parent or Guardian's Email Address
Email
Check to receive information, news, and discounts by e-mail.
Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
Emergency Contact
First Name*
Last Name*
Emergency Contact's Phone Number*
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 Age Acknowledgment*
Parent or Guardian's Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
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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