Good Breeze Kiteboarding Inc dba Ron Jon Kiteboarding
Beach N Board's Fest
WATER SPORTS WAIVER
SPORT PARTICIPANT RELEASE OF LIABILITY, WAIVER OF CLAIMS, EXPRESS ASSUMPTION OF RISK AND INDEMNITY AGREEMENT
Please read and be certain you understand the implications of signing. By signing below, you are confirming your agreement and understanding of what is stated below.
Express Assumption of Risk Associated with Sport, Venue Use and Related Activities.
Name of Participant(s)______________________________________ Age_______
Home Address _________________________________ City______________
State _____ Zip/Postal Code____________
Cell Phone____________________ Home phone __________________________
Local Address/Hotel/Condo name and unit #______________________________
Emergency Contact Name ________________________________
Phone Number ________________________________
List any known medical conditions/limitations (heart condition, high blood pressure, diabetes, asthma, etc.) or allergies to plants or insects (bees, jellyfish, etc.) _________________________________________________________________________________
Are you taking any medication? _______ If yes, what medication are you taking?
Are you currently being treated for any medical condition? ______________________
If yes, what medical condition are you receiving treatment for? ___________________
Physicians Name: ___________________ Physicians Phone No. ________________
I, ________________________________________________ do hereby affirm and acknowledge that I have been fully informed of the inherent hazards and risks associated with activities with Kiteboarding/Kitesurfing/Foilboarding/Kite Foil Board Racing /Water sports or any aspect of these activities, as well as transportation of equipment related to the activities, and traveling to and from activity sites in which I am about to engage. Inherent hazards and risks include but are not limited to:
1. Risk of injury from the activity and equipment utilized is significant including the potential for broken bones, severe injuries to the head, neck, back and/or surfers’ myelopathy, drowning, or other bodily injuries that my result in permanent disability or death.
2. Possible equipment failure and/or malfunction or misuse of my own or others’ equipment, which may result in injury, including those injuries described above.
3. I AGREE THAT I WILL WEAR APPROVED PROTECTIVE GEAR AS DECREED BY THE GOVERNING BODY OF THE SPORT I AM PARTICIPATING IN. However, I understand that protective gear cannot guarantee the participant’s safety. I further agree that no helmet can protect the wearer against all potential head injuries or prevent injury to: the wearer’s face, neck or spinal cord or from surfers’ myelopathy.
4. Variation in terrain, wind, temperature and water conditions, including but not limited to waves, currents, shore break, tides, marine life, blowing sand, trees, rocks, other persons and their equipment, and other natural and man-made hazards.
5. My own negligence and/or the negligence of others, including but not limited to operator error and instructor/guide decision-making including misjudging ocean conditions, weather, equipment or obstacles.
6. Exposure to the elements and temperature extremes may result in heat exhaustion, heat stroke, sunburn, hypothermia and dehydration.
7. Dangers associated with exposure to natural elements included but not limited to tsunami, hurricane, inclement weather, thunder and lightning, severe and/or varied winds, temperature, sea conditions and marine life.
8. Fatigue, exhaustion, chill, and/or dizziness, which may diminish my/our reaction time and increase the risk of accident.
9. Impact or collision with other participants, athletes, spectators, employees, pedestrians, motor vehicles, and cyclists.
*I understand the description of these risks is not complete and unknown or unanticipated risks may result in injury, illness, or death.
Release of Liability, Waiver of Claims and Indemnity Agreement
In consideration for being permitted to participate in the above described activity(ies) and related activities, I hereby agree, acknowledge and appreciate that:
1. I HEREBY RELEASE AND HOLD HARMLESS WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER CAUSED BY NEGLIGENCE OR OTHERWISE, the following named persons or entities, herein referred to as releasees.
Florida Kite Racing League Inc. DBA Florida Kite Racing League
I,_______________________, agree to release the releases, their officers, directors, employees, representatives, agents, and volunteers from any and all liability and responsibility whatsoever and for any claims or causes of action that I, my estate, heirs, survivors, executors, or assigns may have for personal injury, property damage, or wrongful death arising from the above activities whether caused by active or passive negligence of the releasees or otherwise. By executing this document, I agree to hold the releasees harmless and indemnify them in conjunction with any injury, disability, death, or loss or damage to person or property that may occur as a result of my engaging in the above activities.
2. By entering into this Agreement, I am not relying on any oral or written representation or statements made by the releasees, other than what is set forth in this Agreement.
3. This agreement shall apply to any and all injury, disability, death, or loss or damage to person or property occurring at any time after the execution of this agreement.
4. By entering into this Agreement, I am giving up all claims to all copyrights , photos, likeness or press release information to be used by the Florida Kite Racing League.
This release shall be binding to the fullest extent permitted by law. If any provision of this release is found to be unenforceable, the remaining terms shall be enforceable.
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, I FULLY UNDERSTAND ITS TERMS, I UNDERSTAND THAT I HAVE GIVEN UP LEGAL RIGHTS BY SIGNING IT, AND I SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
S/______________________________________ ________________________________________ ________________________
Signature of Adult Participant Name of Adult Participant (Please Print) Date
FOR PARTICIPANTS OF MINORITY AGE: This is to certify that I, as Parent, Legal Guardian, Temporary Guardian with legal responsibility for this participant, do consent and agree not only to his/her release of all Releases, but also to release and indemnify the Releasees from any and all liabilities incident to his/her involvement in these programs for myself, my heirs, assigns,
and next of kin.
S/__________________________________________ _______________________________________ _____________________
Signature of Parent or adult legal Guardian Name of Parent or Adult Legal Guardian (Please Print) Date
If Participant is a Minor, and by their signature, they on my behalf, release all claims that both they and I have.