PARTICIPANT RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT

GREAT RIVER OUTFITTERS, LLC

***READ BEFORE SIGNING***

 
Participant Name (Print): First _____________________ Last: _________________________________

Participant’s Signature: ___________________________    Age ______       Date: ___/___/___   

Address: ______________________________City: _______________ State: __________ Zip: ___________
 
Home Phone: ________________________________ Cell Phone: __________________________________
 
FOR PARENTS/GUARDIANS OF PARTICIPANT OF MINOR AGE (UNDER AGE 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 the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liability incidents to my minor child’s involvement or participation in these programs as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by law.
 
___________________________________________________________     ____________     ______________
Parent/Guardian Signature                                                                                     Age                      Date
 
In consideration of being allowed to participate in any way in Great River Outfitters, LLC activities, operations, services, related events, and the use of Great River Outfitters, LLC equipment, I 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.
 
2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation.
 
3. I willingly agree to comply with terms and conditions for participation. If 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 nearest official immediately.
 
4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS Great River Outfitters, LLC, 36 Park Road, Windsor, Vermont, 05089  its officers, officials, agents and/or employees, other participants, sponsors, advertisers, and, if applicable, owners and lessors of premises used to conduct the event (RELEASEES), from any and all claims, demands, losses, and liability arising out of or related to any INJURY, DISABILITY OR DEATH I may suffer, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.
 
5.  I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT READILY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
 
EQU
QTY
SIZE
DESTINATION 
DROP-OFF
PICK-UP
Canoe
 
 
 
From:
 
 
 
To:
 
 
 
Time:
 
 
 
Time:
Kayak
 
 
Raft
 
 
PFD
 
 
Paddle
 
 
Dry Bag
 
 
Splash Top
 
 
River Map
 
 
Total Number of people in the Group
 
 
Great River Outfitters, LLC 36 Park Road Windsor, Vermont 05089

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802-674-9933