MCCRACKENS CANOE RENTAL 5409 SHAWVILLE HIGHWAY CLEARFIELD, PA 16830
RELEASE OF LIABILITY and PHOTO RELEASE phone: 814-765-1410
READ BEFORE SIGNING. PLEASE PRINT NEATLY. 1 FORM PER PERSON.
Address:________________________________________City, State, Zip________________________________
Phone#_____-_____-________Emergency contact-name and #______________________________________
In consideration of being allowed to participate in this McCrackens Canoe Rental program, its related events and activities,
I, __________________________________________________ the undersigned, acknowledge, appreciate and agree that:
(Read each paragraph and validate by checking the line next to the paragraph)
___ 1. The risk of injuries from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular skills, equipment, and 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 IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and,
___ 3. I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual or significant hazard during my presence or participation, i will remove myself from participation and bring such to the attention of McCrackens Canoe Rental immediately; and,
___ 4. I, for myself and on behalf of my heirs, assigns,personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS McCrackens Canoe Rental, their owners, agents and/or employees, Commonwealth of Pennsylvania-Department of Forestry-Sproal State Forest, other participants, sponsoring agencies, sponsors, advertisers and if applicable owners and leasers of premises used for the activity (“RELEASEES”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, 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; and,
___ 5. I (and my child/guardianship) will pay attention to and adhere to all safety and procedural information and materials provided by McCrackens Canoe Rental.
___ 6. I give McCrackens Canoe Rental permission, in connection with any pictures taken during this Program of me (my child/ guardianship) 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 McCrackens Canoe Rental from any and all claims, demands, arising out of or in conjunction with the use of said photographs.
___ 7. I am aware that a tandem canoe or kayak is designed to carry two adult people, that a solo canoe or kayak is designed to carry one person, that each can carry a moderate amount of gear, and that an overloaded boat can and does become unstable, unpredictable, and dangerous.
___ 8. I take full responsibility for any consequences resulting from my (and my child/guardianship) not adhering to Pennsylvania laws and regulations.
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.
Participants signature:________________________________________________ Age: _______Date signed: _____________
Minors signature:____________________________________________________Age:________Date Signed______________
Minors signature:___________________________________________________Age:_________Date signed______________
Minors signature:________________________________________________________________Date signed_______________
FOR PARENTS/GUARDIANS OF PARTICIPANTS OF MINOR AGE
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 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.
__________________________________________ ___________________________________________________ ____
Parents/guardian signature Print name Date signed