Name
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First Name
Last Name
Mobile Phone
*
(###)
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####
Email Address
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PARTICIPANT RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT: In consideration of being allowed to participate in any way in the program, related events and activities, I the undersigned, acknowledge, appreciate, and agree that: 1. The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death. 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. 3. I willingly agree to comply with terms and conditions for participation. If I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately.
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I agree
I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY,AND HOLD HARMLESS PINNIPED KAYAK, LLC , its officers, officials, agents and/or employees, other participants, sponsors, advertisers, and, if applicable, owners and lessors of premises used to conduct the event (RELEASEES), from any and all claims, demands, losses, and liability arising out of or related to any INJURY, DISABILITY OR DEATH I may suffer, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law. 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. By entering my initials below, I indicate that I have read and agree to all these conditions for participation.
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Age
Do you or have you had any of the following medical conditions??
Please check all that apply. (answers are confidential, and strictly for use by instructional staff)
Diabetes or hypoglycemia?
Orthopedic problems (back, shoulder, hip, knee, etc)?
Circulatory problems (chest pain, heart attack, BP, fainting)?
Allergies or Asthma?
If you checked any of the above, please provide details below.
If there are any other conditions that may affect your participation in this course, please include those as well.
When you walk a mile (15-20 min. pace) do you experience shortness of breath, chest pain, or other discomfort?
Yes
No
How comfortable are you swimming with your face in the water?
Not Comfortable
Somewhat Comfortable
Very Comfortable
THANKS FOR REGISTERING ! If you are signing up for more than one course, please hit "refresh", enter your next course date, and submit the form again.
DEPOSIT POLICY : You’ll receive an email (within a day or two) with a link to our deposit payment system. Your 50% deposit reserves your spot and helps us plan for consistent class sizes. If you cancel 15 days in advance, your deposit will be refunded (minus 3% credit card transaction fee), or credited in full to a future course. If you cancel less than 15 days before the course date, your deposit can only be refunded if we are able to fill your vacant spot. If Pinniped Kayak cancels a course for any reason, your deposit will be refunded in full.
Waitlist : If a course that you have registered for is full, we will contact you within a day of receiving this form. We can add you to a waitlist, or discuss options for similar courses that would suit you.