This form must be filled out in its entirety, printed and submitted upon arrival!

                                                 HOMETOWN RIVER CO. INC.   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,


                          (1)   ____________________________________                      (2) _________________________________ 

                                         (print renters full legal name)                                              (print renters full legal name)



                       (3)  _____________________________________                     (4) _________________________________

                                         (print renters full legal name)                                              (print renters 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 while 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 I acknowledge that I  have no physical or metal condition(s) that would prevent me from safely participating in said activities. I acknowledge that I have insurance to cover any injury or damage I may sustain or cause while participating in said activities. I acknowledge that any and all cost associated with an personal injury or damage to myself are my sole responsibility. 

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, administrators, personal representatives, estate and next of kin, HEREBY FULLY RELEASE, INDEMNIFY, AND HOLD HARMLESS HOMETOWN RIVER COMPANY, INC. , their owners, 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 FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law, and I do agree that I shall not bring any demands, claims, or legal actions against Hometown River Company, Inc., for losses or liability arising out of or related to any injury, disability, loss of use, or death I may suffer, or otherwise specifically related to COVID-19, to the fullest extent permitted by law. 

5.  I consent to the use of address and email for contact, and photo/video taken of me by Hometown River Company, Inc., or provided by me for publicity, websites or any other use, and expressly waive any right of privacy.  

6.  Renter or Guardian is responsible for all cost associated with damages, loss or theft of rental equipment, including but not limited to vandalism or theft, and shall pay HRC the fill cost of repair or replacement.  PFD Lost/Damaged: $20, Kayak Lost/Stolen: $ List price of Kayak replacement, Broken Seat: $50, Bow/Stern Damage: $100, Kayak Paddle Damaged/Lost: $45, Cooler Floats Lost/Damaged $20, Tubes Lost/Damaged: $30-$60


7. I acknowledge that I, myself and any minor I am signing as legal guardian for can swim.

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.  

Signer acknowledges he/she is 18 years or older and has read this document.

 

(1)_________________________________________________                  (2)__________________________________________
                            (Renter's Signature)                                    (Date)                                                  (Renter's Signature)                                      (Date)


(3)_________________________________________________                   (4)__________________________________________
                           (Renter's Signature)                                                    (Date)                                                                   (Renter's Signature)                                      (Date)
 

Emergency Contact Name:___________________________________________         Phone #: ____________________________


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(s), do consent and agree to his/her release as provided above of all Releasees and for myself, my child and heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees of any and all liability incidents to my minor child’s involvement or participation in these activities provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest amount permitted by law.

 

X_______________________________________________            Date Signed:_____________
                    (PARTENT/GURDIAN’S SIGNATURE)

 

X_______________________________________________           Age:____________
                                (Print Childs Name)

X_______________________________________________           Age:____________
                                (Print Childs Name)

X_______________________________________________           Age:____________
                                  (Print Childs Name)

X_______________________________________________           Age:____________

                                (Print Childs Name)