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Waiver and Release of Liability (Minor)

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In consideration of Paddle Shack furnishing services and/or equipment to enable my child to participate in any Paddle Shack activity, I agree as follows:

I fully understand and acknowledge that recreational activities have: (a) inherent risks, dangers and hazards, such exists in my use of Paddle Shack equipment and my participation in Paddle Shack activities; (b) my participation in such activities and/or use of such equipment may result in injury or illness including, but not limited to bodily injury, disease, strains, fractures, partial and/or total paralysis, death, or other ailments that could cause serious disability; (c) these risks and dangers may be caused by the negligence of the owners, employees, officers, or agents of Paddle Shack; the negligence of others, accidents, breaches of contract, forces of nature, or other causes. Risks and dangers may arise from foreseeable and unforeseeable causes including but not limited to, guide/supervisor decision making, including that a guide/supervisor may misjudge terrain, weather, trail or water route, location, or conditions, risks of falling out of or drowning while in a kayak, canoe, or raft, and other such risks, hazards and dangers that are integral to recreation activities and/or use of equipment, I hereby assume all risks and dangers and all responsibility for any losses and/or damages, whether caused in whole or in part by the negligence or other conduct of the owners, employees, officers, or agents of Paddle Shack, or by any other person.

 

I, on behalf of myself, my personal representatives, and heirs hereby voluntarily agree to release, waive, discharge, hold harmless, defend and indemnify Paddle Shack and its owners, agents, officers, and employees from any and all claims, actions or losses of bodily injury, property damage, wrongful death, loss of services or otherwise which may arise out of my use of Paddle Shack equipment or my participation in Paddle Shack activities. I specifically understand that I am releasing, discharging and waiving any claims or actions that I may have presently or in the future for the negligent acts or other conduct by the owners, employees, officers, or agents of Paddle Shack.

The venue of any dispute that may arise out of this agreement or otherwise between the parties to which Paddle Shack or its agents is a party shall be either the Township of Hamilton, New Jersey Justice Court, or State Supreme Court in Atlantic County, New Jersey.


I have read the above, and by signing agree with the terms mentioned above.
I grant permission for my child to participate in Paddle Shack activities, and assume and accept all risks there with. I also state that I am the legal parent or guardian of the child as noted.

 

 
 
_______________________________________________________________________
parent/guardian signature

____________
age

__________
date
 
 
_______________________________________________________________________
name (printed)
Does child have any medical or physical conditions that we should be aware of in case of emergency?

circle one:          Yes        NO
If "Yes" please detail on Personal Info Page

 
 
_______________________________________________________________________
street address
 
 
_______________________________________________________________________
town

____________
state

____________
zip code
 
 
_______________________________________________________________________
child's name (printed)


____________
child's age

   
 


_______________________________________________________________________
child's signature

     
 


Activity: __Instruction  __ Rental   __Tour   __Test Paddle  __Other ____________________________

 
 


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Link to: Minor Emergency Personal Information Form

 

   

 


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