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Water Waiver
Water Waiver
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This field is for validation purposes and should be left unchanged.
Name
Date of Birth
MM slash DD slash YYYY
Date
MM slash DD slash YYYY
Address
City, State, Zip Code
Cell Phone
Home Phone
In consideration of being allowed to participate in any way in the South Mountain Adventures, LLC programs, its related events, activities and equipment use, I the undersigned,
Name
acknowledge, appreciate, and agree that: (READ EACH PARAGRAPH AND VALIDATE ITS CONTENT BY SELECTING THE BUTTON TO THE RIGHT OF SAID PARAGRAPH)
Hereinafter, I acknowledge the following definitions and acronyms: SMA represents South Mountain Adventures, LLC “Program” includes participation in any activities, programs, or related events planned, organized, managed, conducted, supported, guided or sponsored by South Mountain Adventures, LLC, and/or the use of South Mountain Adventures, LLC, equipment.
Yes
The risk of injury and physical stresses from the activities involved in this Program are significant, including the potential for permanent paralysis and death, and while particular skills, equipment and personal discipline may reduce this risk, the risk of serious injury does exist; and,
Yes
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; and,
Yes
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 South Mountain Adventures, LLC, immediately; and
Yes
I, for myself and on behalf of my heirs, assigns, personal representative and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS South Mountain Adventures, LLC, 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, DISEASE, DISABILITY, DEATH, LOSS OF SERVICES, or loss or 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.
Yes
I (and my child/guardianship) will pay attention to and will adhere to all safety and procedural information and materials provided by South Mountain Adventures, LLC.
Yes
I give South Mountain Adventures, LLC, permission, in connection with any photographs taken during this Program of me (and my child/guardianship) or in which I (and/or my child/guardianship) am included with others, the right to use and reuse, in any manner at all, photographs in whole or in part, either by themselves or in conjunction with other photographs, in any medium and for the purposes whatsoever, including without limitation, all promotional and advertising uses, and other trade purposes. I hereby release South Mountain Adventures, LLC, from any and all claims, actions, and demands arising out of or in conjunction with use of said photographs.
Yes
No
I am aware that a tandem kayak is designed to carry two adult people, that a tandem kayak fitted with one seat and a solo kayak is designed to carry one person, that each can carry a moderate amount of gear, and that an overloaded boat can be unstable, unpredictable, and dangerous. Weight limits are prescribed and shall be adhered to.
Yes
I take full responsibility for any consequences resulting from my (and my child/guardianship) not adhering to Pennsylvania laws and regulations. The PA Laws that are applicable to non-power boating are: I. It is illegal to operate a boat (including canoes and kayaks) while under the influence of alcohol or a controlled substance. A blood alcohol content of 0.08% or greater is considered to be over the legal limit. If convicted, fines, incarceration and loss of boating privileges can be imposed. Alcohol is prohibited at all PA State Parks, and on PFBC property. South Mountain Adventures, LLC, prohibits the use of alcohol and drugs while on the water. II. It is against the law to litter. I will keep all loose debris securely contained within a bag or container. III. Any boat must have on board a USCG approved wearable life jacket (PFD) for each person. South Mountain Adventures, LLC, strongly recommends PFD use at all times and especially during difficult conditions. Children 12 years of age and younger are required to wear PFDs while on Commonwealth waters. South Mountain Adventures, LLC, requires that non-swimmers wear their PFD at all times when on the water. I am responsible for keeping the appropriate PFD(s) in the boat and readily accessible to each person on board. IV. A manually powered boat on the water between the hours of sunset and sunrise is required to have on board a white light which must be displayed in sufficient time to avoid a collision with another water craft. I am responsible for providing such lighting at said times.
Yes
I understand and accept that I am responsible for returning all equipment rented in “as received” condition or replacing it at cost.
Yes
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 FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. I CERTIFY THAT I POSSESS FULL LEGAL CAPACITY TO EXECUTE THE FOREGOING AUTHORIZATION.
Signature
Date
MM slash DD slash YYYY
FOR PARENTS/GUARDIANS OF PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT TIME OF SIGNING)
Name 1
Age 1
Weight 1
Name 2
Age 2
Weight 2
Name 3
Age 3
Weight 3
Name 4
Age 4
Weight 4
Name 5
Age 5
Weight 5
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 and our heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident 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’s Signature
Date
MM slash DD slash YYYY
