ACCIDENT WAIVER AND RELEASE OF LIABILITY FORM

Name of the Activity or Event: _Hillsdale Lake Boating Trip_Date of Activity or Event: Jly
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& HE'EB( A))*+E ALL ,- THE '&).) ,- /A'T&0&/AT&N1 &N TH&) A0T&2&T( ,'
E2ENT3 inclding 4y 5ay of e6ample and not limitation3 any risks that may arise from
negligence or carelessness on the part of the persons or entities 4eing released3 from
dangeros or defective e7ipment or property o5ned3 maintained3 or controlled 4y them3
or 4ecase of their possi4le lia4ility 5ithot falt8
& certify that & am physically fit3 have sfficiently prepared or trained for participation in the
activity or event3 and have not 4een advised to not participate 4y a 7alified medical
professional8 & certify that there are no health9related reasons or pro4lems 5hich
preclde my participation in this activity or event8
& ackno5ledge that this Accident :aiver and 'elease of Lia4ility -orm 5ill 4e sed 4y the
event holders3 sponsors3 and organi;ers of the activity or event in 5hich & may
participate3 and that it 5ill govern my actions and responsi4ilities at said activity or event8
&n consideration of my permitting me to participate in this event3 & here4y take action for
myself3 my e6ectors3 administrators3 heirs3 ne6t of kin3 sccessors3 and assigns as
follo5s:
<A= & :A&2E3 'ELEA)E3 AND D&)0HA'1E from any and all lia4ility3 inclding 4t not
limited to3 lia4ility arising from the negligence or falt of the entities or persons released3
for my death3 disa4ility3 personal in>ry3 property damage3 property theft3 or actions of any
kind 5hich may hereafter occr to me inclding my traveling to and from this event3 THE
-,LL,:&N1 /E'),N): .ai ?3 +ing6in ? and their family mem4ers@
<B= & &NDE+N&-(3 H,LD HA'+LE))3 AND /',+&)E N,T T, )*E the persons
mentioned in this paragraph from any and all lia4ilities or claims made as a reslt of
participation in this activity or event3 5hether cased 4y the negligence of release or
other5ise8
& ackno5ledge that .ai ?3 +ing6in ? and their family mem4ers are N,T responsi4le
for the errors3 omissions3 acts3 or failres to act of any party or entity condcting this
4oating event8
& ackno5ledge that this activity or event may involve a personAs physical limits and may
carry 5ith it the potential for death3 serios in>ry3 and property loss8 The risks may
inclde3 4t are not limited to3 those cased 4y terrain3 facilities3 temperatre3 5eather3
condition of participants3 e7ipment3 vehiclar traffic3 actions of other people inclding3
4t not limited to3 participants3 and event monitors3 andBor organi;ers of the event3 and
lack of hydration8 These risks are not only inherent to participants3 4t are also present
for organi;ers8
& here4y consent to receive medical treatment 5hich may 4e deemed advisa4le in the
event of in>ry3 accident3 andBor illness dring this activity or event8
The accident 5aiver and release of lia4ility shall 4e constred 4roadly to provide a
release and 5aiver to the ma6imm e6tent permissi4le nder applica4le la58
& 0E'T&-( THAT & HA2E 'EAD TH&) D,0*+ENT3 AND & -*LL( *NDE')TAND &T)
0,NTENT8 & A+ A:A'E THAT TH&) &) A 'ELEA)E ,- L&AB&L&T( AND A 0,NT'A0T
AND & )&1N &T ,- +( ,:N -'EE :&LL8
____________________________________________________________________
/rint /articipantAs Name Age )ignatre Date
<if nder $" years old3 /arent or gardian mst also sign=
/A'ENT B 1*A'D&AN :A&2E' -,' +&N,') <*nder $" years old=
The ndersigned parent and natral gardian does here4y represent that heBshe is3 in
fact3 acting in sch capacity3 has consented to hisBher child or 5ardAs participation in the
activity or event3 and has agreed individally and on 4ehalf of the child or 5ard3 to the
terms of the accident 5aiver and release of lia4ility set forth a4ove8 The ndersigned
parent or gardian frther agrees to save and hold harmless and indemnify each and all
of the parties referred to a4ove from all lia4ility3 loss3 cost3 claim3 or damage 5hatsoever
5hich may 4e imposed pon said parties 4ecase of any defect in or lack of sch
capacity to so act and release said parties on 4ehalf of the minor and the parents or legal
gardian8
_____________________________________________________________________
/rint /articipantAs Name Age )ignatre of /arent or 1ardian Date