Accident Waiver And Release Of Liability Form Page 3
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3ACCIDENT WAIVER AND RELEASE OF LIABILITY
I acknowledge that this athletic event is an extreme test of a person’s physical and mental limits and carries with it the
potential for death, serious injury and property loss. The risks include but are not limited to, those caused by terrain,
facilities, temperature, weather, condition of athlete, equipment, vehicular traffic, actions of other people including, but not
limited to, participants, volunteers, spectators, coaches, event officials, and event monitors, and/or producers of the event,
and lack of hydration. These risks are not only inherent to athletes but are also present for volunteers. I hereby assume all
of the risks of participating and/or volunteering in this event. I realize that liability may arise from negligence or carelessness
on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained
or controlled by them or because of their possible liability without fault.
I certify that I am physically fit, have sufficiently trained for participation in the event and have not been advised otherwise by
a qualified medical person.
I acknowledge that this Accident Waiver and Release of Liability form will be used by the event holders, sponsors and
organizers, in which I may participate and that it will govern my actions and responsibilities at said events.
In consideration of my application and permitting me to participate in this event, I hereby take action for myself, my
executors, administrators, heirs, next of kin, successors, and assigns as follows: (A) Waive, Release and Discharge from any
and all liability for my death, disability, personal injury, property damage, property theft or actions of any kind which may
hereafter accrue to me including my traveling to and from this event. THE FOLLOWING ENTITIES OR PERSONS: CITY OF
BANGOR, TOWN OF KENDUSKEAG, DIRIGO SEARCH & RESCUE, LINCOLN SEARCH AND RESCUE, OTHER SAFETY
ENTITIES OR PERSONS, AND KENDUSKEAG STREAM CANOE RACE COMMITTEE their directors, officers, employees,
volunteers, representatives, and agents the event holders, event sponsors, event directors, event volunteers; (B) Indemnify
and Hold Harmless the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result
of participation in this event, whether caused by the negligence of releases or otherwise.
I hereby consent to receive rescue and emergency first aid treatment in the event of injury, accident and or illness during this
event.
I understand that at this event or related activities, I may be photographed. I agree to allow my photo, video or film likeness
to be used for any legitimate purpose by the event holders, producers, sponsors, organizers and or assigns.
This Accident Waiver and Release of Liability shall be construed broadly to provide a release and waiver to the maximum
extent permissible under applicable law.
By checking the box below, I hereby certify that I have read this document and, I understand its content.
________________________________
________ ___________________________________________ _________
Participant’s Name (Print)
Age
Signature
Date
________________________________
________ ___________________________________________ _________
Participant’s Name (Print)
Age
Signature
Date
________________________________
________ ___________________________________________ _________
Participant’s Name (Print)
Age
Signature
Date
________________________________
________ ___________________________________________ _________
Participant’s Name (Print)
Age
Signature
Date
PARENT GUARDIAN WAIVER FOR MINORS (UNDER 18 YEARS OLD)
The undersigned parent and natural guardian or legal guardian does hereby represent that he/she is, in fact,
acting in such capacity and agrees to save and hold harmless and indemnify each and all of the parties referred
to above from all liability, loss, cost, claim or damage whatsoever which may be imposed upon said parties
because of any defect in or lack of such capacity to so act and release said parties on behalf of the minor and
the parents or legal guardian.
________________________________
________ ___________________________________________ _________
Parent or Guardian Name (Print)
Age
Signature
Date
________________________________
________ ___________________________________________ _________
Parent or Guardian Name (Print)
Age
Signature
Date
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