Voluntary Release Of Liability, Hold Harmless, Indemnification, Assumption Of Risks, And Informed Consent For Water Sports Activities Form/alabama 4-H Youth Consent Form
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3VOLUNTARY RELEASE OF LIABILITY, HOLD
HARMLESS, INDEMNIFICATION, ASSUMPTION
OF RISKS, AND INFORMED CONSENT FOR
WATER SPORTS ACTIVITIES
____________________
Program Information
Program:
RiverKids, WaterWatch, and/or Sportfishing
Dates:
September 1, 2016-July 31, 2017
Location:
Participant Information
Name
Email Address:
Street Address
City
State
Zip
Home Phone
Work Phone
Date of Birth
/
/
Gender M
F
PLEASE READ THIS “RELEASE” CAREFULLY BEFORE SIGNING. THIS IS
2. Waiver of Claims
A LEGALLY BINDING DOCUMENT. THIS FULLY SIGNED FORM MUST BE
SUBMITTED BEFORE ANY PERSON IS ALLOWED TO PARTICIPATE.
I hereby release the Alabama 4-H, the Alabama Cooperative Extension System,
Auburn University, its Board of Trustees, Administration, Faculty, Staff, Student
I, the undersigned, wish to participate in the above referenced event
Leaders, and all other officers, directors, employees and agents (hereafter
(hereafter “Event”) on the date(s) and location as indicated above and, in
“Auburn”) from any and all liability as to any right of action that may accrue to my
consideration for my participation, I hereby agree as follows:
heirs or representatives for any injury or loss that I may suffer while training,
1. Assumption of Risks
preparing, participating and/or traveling to or from the Event. This agreement is
binding on my heirs and assigns.
I acknowledge, understand and appreciate that as part of my participation in the
Event there are dangers, hazards and inherent risks to which I may be exposed,
3. Hold Harmless
including the risk of serious physical injury, temporary or permanent disability,
I furthermore release, indemnify and hold harmless Auburn from and against any
and death, as well as economic and property loss. I further realize that
and all liability, actions, debts, claims and demands of every kind whatsoever,
participating in the Event may involve risks and dangers, both known and
specifically including, but not limited to, any claim for negligence or negligent acts
unknown, and have elected to take part in the Event. To a large extent, these
or omissions and any present or future claim, loss or liability for injury to person
risks, dangers and hazards derive from the nature of the activities and the
or property that I may suffer, for which I may be liable to any other person, that
environment in which they take place. I agree that if I am not knowledgeable of
may or does arise out of my participation in the Event. I understand that Auburn
the risks associated with Event activities I will obtain proper instruction in order to
accepts no responsibility for my personal property.
gain a full appreciation of the risks, dangers and hazards associated with these
activities.
4. Authorization for Medical Care
In the event of an accident or serious illness, I hereby authorize representatives
I am aware of injuries, death and property damage which can result from paddle
sports and watercraft activities including, but not limited to: falling, capsizing or
of Auburn to obtain medical treatment for me and on my behalf. I hereby hold
being flipped into the water (either intentionally or unintentionally); tidal conditions
harmless and agree to indemnify Auburn from any claims, causes of action,
and currents; travel in remote areas; collisions with objects in or underneath the
damages and/or liabilities, arising out of or resulting from said medical treatment.
surface or other watercraft; prolonged exposure to cold water; hypothermia;
I further agree to accept full responsibility for any and all expenses, including
hyperthermia; death by drowning; mental anguish or trauma; unavailability of life
medical expenses that may derive from any injuries that may occur during my
saving services or immediate medical attention in the case of injury; adverse
participation in the Event.
weather conditions – exposure to cold, sun, wind, storms, waves and lightening;
This RELEASE contains the entire agreement between the parties to this
quickly changing weather conditions; quickly changing water conditions; contact
agreement and the terms of this RELEASE are contractual and not a mere
with aquatic and land animals, including insects and wildlife, in the water, along
recital. The information I have provided is disclosed accurately and
the shore or in camp; rocks or other debris falling from overhanging shore areas;
truthfully. I have been given ample to read this document and I understand
difficult terrain or walking conditions along the shore, including mud, rocks, steep
and agree to all of its terms and conditions. I understand that I am giving
slopes, and marine life; entrapment or being crushed while in a watercraft; my
up substantial rights (including my right to sue), and acknowledge that I am
own and other participants' attempts to exceed watercraft skills and/or acting in a
signing this document freely and voluntarily, and intend by my signature to
reckless manner; my own failure or that of other participants to follow the safety
provide a complete and unconditional release of all liability to the greatest
guidelines and other instructions of trip initiators, including always wearing shoes
extent allowed by law. My signature on this document is intended to bind
and a personal flotation device; improper use of equipment; vehicular or
not only myself but also my successors, heirs, representatives,
pedestrian accident while being transported or walking to or from activity sites.
administrators, and assigns.
I am aware that Event activities may involve strenuous exertion of strength using
A PARENT OR GUARDIAN MUST SIGN THIS FORM FOR A MINOR UNDER
various muscle groups, athletic movements and change of direction, and
THE AGE OF 19
sustained physical activity which places stress on the musculoskeletal and
cardiovascular system. Risks from each of these activities include: minor injuries
Participant Name
such as scratches, bruises and sprains/strains; major injuries such as bone
fractures, joint or back injuries, eye injuries, concussions and heart attacks; and
Participant Signature
catastrophic injuries such as paralysis or death. I declare and affirm that my
Date
medical and physical condition allows me to participate in physical activities and
do not pose any danger to my health.
Parent/Guardian Name
Therefore I voluntarily accept and assume all risk of injury, loss of life or damage
Parent/Guardian Signature
to property arising out of training, preparing, participating and traveling to or from
Date
the Event. I understand that I am responsible for my own insurance.
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