This form must be filled out in its entirety, printed and submitted upon arrival!
Hometown River Company
(staff use only/completed by:_________)
SK:_______ SKS:_______ APFD:______ P#:_______ Run Time: Bus: ______
TK:_______ TKS:_______ YPFD:______ Van:______
RELEASE OF LIABILITY
In consideration of being allowed to participate in any way in the Hometown River Company programs, its related events, and activities, and use of any facilities, I
(print full legal name)
The undersigned acknowledge, appreciate, and agree that:
1. The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular skills, equipment, and personal discipline may reduce the risk, the risk of serious injury does exist: and,
2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation: and,
3. I willingly agree to comply with the stated and customary terms and conditions for participation.If, however, I observe any unusual significant hazard during my presence or participation I will remove myself from participation and bring such to the attention of the Company and Staff immediately and,
4. I, for myself and on the behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS HOMETOWN RIVER COMPANY, their officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used for the activity (“releasees”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss of damage to person or property associated with my presence or participation, WHETHER ARISING FORM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law, and
5. Address, e-mail, and photo release for Hometown River Company promotion use.
6. Customer is responsible for all cost for damages to rental equipment.
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, I FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
FOR PARENTS/GUARDIANS OF PARTICIPANTS OF MINORITY AGE
(UNER AGE OF 18 AT TIME OF REGISTRATION)
This is to certify that I, as parent/guardian with legal responsibility for this participant do consent and agree to his/her release as provided above of all Releasees and for myself, my child an d heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees of any and all liabilities incident to my minor child’s involvement or participation in these programs provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest amount permitted by law.
X_______________________________________________ Date Signed:_____________
(PRINT CHILD NAME)
Participant/Parent’s Address:_____________________________________________________ Hometown River Company