Icarus surfclub Zeebrugge / surfcity VZW
Please read and be certain you understand the implications of signing. By signing below, you are confirming your agreement and understanding of what is stated below. Express Assumption of Risk Associated with Sport, Venue Use and Related Activities. In consideration of being allowed to participate in watersport events and activities and/or being provided with watersport recreational property or services, for myself and any minor children for whom I am parent, legal guardian or otherwise responsible, and for my own heirs, personal representatives or assigns:
ACKNOWLEDGEMENT OF RISKS: I do hereby affirm and acknowledge that I have been fully informed of the inherent hazards and risks associated with activities with Kiteboarding, and related activities transportation of equipment related to the activities, and traveling to and from activity sites in which I am about to engage. Inherent hazards and risks include but are not limited to: (1) Changing water flow, tides, currents, wave action and ships wakes: (2) Collision with any of the following: other participants, the watercraft, other watercraft and manmade or natural objects: (3) Wind soar, inclement weather, lightning, variances and extremes of wind, weather and temperature: (4) My sense of balance, physical coordination, ability to operate equipment, swim, and/or follow directions: (5) Collision, capsizing, sinking or other hazard which results in wetness, injury, exposure to the elements, hypothermia, and/or drowning: (6) The presence of insects and marine life forms: (7) Equipment failure or operator error: (8) Heat or sun related injuries or illnesses, including sunburn, sunstroke or dehydration: (9) Fatigue, chill and/or dizziness which may diminish my/our reaction time and increase the risk of an accident. (10) Cuts and lacerations from submerged objects and debris (11) Any injury incurred while utilizing training equipment, including but not limited to kiteboarding, kitesurfing, kite flying, wakeboarding, paddleboarding, indoor kite bar swing, skateboarding, balance board, Boom time, jetski usage, and any additional training equipment or lesson activity deemed fit by Icarus surfclub. (11) Risk of injury from the activity and equipment utilized is significant including the potential for broken bones, severe injuries to the head, neck, back and/or surfers’ myelopathy, drowning, or other bodily injuries that my result in permanent disability or death. (12) Possible equipment failure and/or malfunction or misuse of my own or others’ equipment, which may result in injury, including those injuries described above.
EXPRESS ASSUMPTION OF RISK AND RESPONSIBILITY: I Agree to assume responsibility for all the risks of the activity, whether identified above or not (EVEN THOSE RISKS ARISING OUT OF THE NEGLIGENCE OF THE RELEASEES NAMED BELOW). My/our participation in the activity is purely voluntary. I assume full responsibility for myself and any other minor children for whom I am responsible, for any bodily injury, accident, illness, paralysis, death, loss of personal property and expenses thereof as a result of any accident which may occur while I/we participate in the activity. I AGREE THAT I WILL WEAR APPROVED PROTECTIVE GEAR AS DECREED BY THE GOVERNING BODY OF THE SPORT I AM PARTICIPATING IN. However, I understand that protective gear cannot guarantee the participant’s safety. I further agree that no helmet can protect the wearer against all potential head injuries or prevent injury to: the wearer’s face, neck or spinal cord or from surfers’ myelopathy.
RELEASE: I hereby release Icarus surfclub Zeebrugge / Surfcity vzw heir principals, directors, officers, members, employees and volunteers, their insurers and each and every land owner, municipal and/or governmental agency upon whose property an activity is conducted ("owner") and their insurers, if any, (Collectively "Releases") FROM ANY AND ALL LIABILITY OF ANY NATURE FOR ANY AND ALL INJURY OR DAMAGE (INCLUDING DEATH) TO ME OR MY MINOR CHILDREN AND OTHER PERSONS as a result of my/our participation in the activity, EVEN IF CAUSE BY THE NEGLIGENCE OF ANY OF THE RELEASEES NAMED ABOVE, OR ANY OTHER PERSON (INCLUDING MYSELF). By entering into this Agreement, I am not relying on any oral or written representation or statements made by the releases, other than what is set forth in this agreement. This agreement shall apply to any and all injury, disability, death, or loss or damage to person or property occurring at any time after the execution of this agreement.
I HAVE READ THIS ASSUMPTION AND ACKNOWLEDGMENT OF RISKS AND RELEASE OF LIABILITY AGREEMENT, I UNDERSTAND THAT SIGNING THIS DOCUMENT, I AM WAIVING VALUABLE LEGAL RIGHTS, INCLUDING ANY AND ALL RIGHTS I MAY HAVE AGAINST NY KITE CENTER AND PEREIRA ADVENTURE SPORTS LLC, THEIR OFFICERS, DIRECTORS AND THEIR EMPLOYEES, AGENTS, SERVANTS OR ASSIGNS.
Participant's Name (printed) ______________________________________________ Age _______
Date: _________________ Signature ____________________________________________________
If participant is under 18, the parent or legal guardian must also sign__________________________
Please list any known allergies to plants, insects, or medications. Please list any medical conditions that may impact your ability to participate in watersports or related activities (if more space is required, attach extra pages)