Adult Participant Agreement Form printable pdf download

HARPERS FERRY ADVENTURE CENTER INC WATER ACTIVITIES

ADULT PARTICIPANT AGREEMENT

In consideration of being allowed by Harpers Ferry Adventure Center Inc, (hereinafter, “HFAC”) to

participate in HFAC Water Activities, I hereby acknowledge, represent and agree that I have read and fully

understand the separate document entitled Terms and Conditions for Participation in Harpers Ferry Adventure

Center Inc Water Activities. The provisions of those Terms and Conditions are organized in that document under

paragraphs numbered and titled as follows:

1. Acknowledgement of the Scope of the Water Activities Covered:

2. Acknowledgement of Risks of Water Activities, Representation of Individual Capacity and Assumption

of Risk:

3. Agreement to Duties Of Participant and Of HFAC And Agreement To HFAC’s Limited Liability:

4. Participant’s Waiver, Release and Indemnity:

5. Acknowledgement and Agreement to Participant’s Own Responsibility for Personal Property:

6. Permission for Use of Publicity Items:

7. Choice of Legal Forum, Application of Terms and Conditions, and Severability of Provisions:

All of the provisions of the Terms and Conditions for Participation in Harpers Ferry Adventure Center Inc

Water Activities in their entirety are adopted and incorporated by reference in this Agreement. I hereby

acknowledge, agree to and commit to abide by all of the provisions of the aforesaid Terms and Conditions for

Participation in Harpers Ferry Adventure Center Inc Water Activities.

PLEASE LEGIBLY AND FULLY COMPLETE THE FOLLOWING BLANK SPACES

LAST NAME: ________________________________FIRST NAME:_______________________________

GROUP NAME (IF APPLICABLE):__________________________________________________________

ADDRESS:_______________________________________________________ ZIP:____________________

CITY:____________________________________ STATE: ____________________

HOME PHONE: _____________________________ MOBILE PHONE: ____________________________

AGE: ___________DATE OF BIRTH: ___________

EMAIL: _____________________________________You will be added to our enews list for events, news, news and

special offers. If you later decide you do not want to receive this info, you can unsubscribe.

I HAVE PRESCRIBED MEDICATIONS ON MY PERSON FOR USE IN A CRISIS:

Yes:___________ No: ________(check one).

If yes, you are responsible for advising your guide of this on any guided trip.

I AM LITERATE AND FLUENT IN THE ENGLISH LANGUAGE. I HAVE READ AND UNDERSTAND THIS

AGREEMENT AND THE TERMS AND CONDITIONS FOR PARTICIPATION IN HARPERS FERRY

ADVENTURE CENTER INC WATER ACTIVITIES , AND AGREE TO ALL OF THE PROVISIONS OF EACH

DOCUMENT: YES_______ NO__________(CHECK ONE)

SIGNATURE OF PARTICIPANT: ________________________________________________

DATE OF SIGNATURE:___________________________

HOW DID YOU HEAR ABOUT US? Google___

Other Internet Search___

Past/Repeat Customer___

Referral___ Facebook ___ Washington Post ____ Living Social ___ Radio/TV ____

Other print ad (please list):

Harpers Ferry KOA Other (please list):____________________

AdultWaterAgtARev 053012

Adult Participant Agreement Form