Participant's Name:
_____________________________________________________________
Address:
_____________________________________________________________
Phone:
_______________________________________________________________________________________
I hereby acknowledge that I am
aware of the inherent dangers to life and limb involved in kayaking such as
underwater entrapment and
concussion; cold water and hypothermia; and disorientation. I have had the
opportunity to ask questions and
am satisfied that I understand the risks and can cope with them.
I, nor my family or heirs will
hold Kayak Adventures and Jan Caldwell Aquatics and/or their owners,
directors,
employees and agents liable
whatsoever for any personal injury, loss or death which may result from my
participation in this event or
trip. I am satisfied with the safety equipment which has been provided, I
understand how to use it and
will use it as required. I am not under the influence of drugs or alcohol
and will not consume either
during this event.
Participant's Signature/parents or guardian and date:
________________________________________________________________________________________
Witness Signature and date:
________________________________________________________________________________________
Dated: