PAN AMERICAN DRAGON BOAT ASSOCIATION, LLC

WAIVER OF LIABILITY RELEASE

INDEMNIFICATION AND HOLD HARMLESS NOTICE

I, the undersigned, in consideration for receiving permission to use the property and equipment of and/or participate in any event organized and/or run by the Pan American Dragon Boat Association, LLC (“PanAm”),and to enter the premises, waterways and grounds supervised or in any way controlled by PanAm, and the receipt of said permission being hereby acknowledged, do hereby forever RELEASE any and all liability, discharge and agree not to sue PanAm together with their respective agents, members, partners, trustees, representatives, officers, sponsors, licensors, servants, volunteers, contractors or employees, and specifically;

1. Events In Motion LLC
2. Citrus County Education Foundation
3. Citrus County ParksRecreation
hereinafter known as the releasees.

I agree to hold and save the releasees harmless and indemnify them from and against any and all liabilities, claims, injuries, losses, damages, expenses, demands, actions, and causes of action whatsoever of any kind or nature arising out of or related to any such loss, damage, or injuries, including death, that may be sustained by me, for whatever reason, while enroute to or from, or participating in or upon, the grounds supervised or controlled by PanAm, whether such damages are the result of negligence, or for any other reason or cause.

I also agree to and discharge forthwith, on request of the releasees, each and every obligation or claim which will be made, assigned, or apportioned against the releasees by any party by virtue of any injury or damage caused to me.

I am duly aware of the risks and hazards inherent in the sport of dragon boating and related paddling sports, and upon entering the premises used for the purpose of launching, docking and storing equipment used in the sport of dragon boating and related paddling activities. In choosing to participate in dragon boating activities, knowing that conditions may be hazardous and dangerous, that obstructions may exist, and that high winds may exist and cause rough waters, I hereby voluntarily assume all risks of loss, damage or injury, including death, that may be sustained by me, or to any property, while in or upon said premises, or engaged in said activity. This Waiver includes injuries, damages, or loss occurring on the premises, on the water, in the water, or in the air while participating in such activity.

In signing this Waiver, I acknowledge and represent that I have read and understand this release and agree to it voluntarily. I further understand that I am specifically waiving certain rights by this release to which I may have otherwise been entitled. I attest that I am at least 18 years of age and of sound mind. (If under 18 years of age, parent/guardian signature is required.)

Team Name:
Your Name: / Date of Birth:
Your address:
Emergency contact: / Contact’s telephone #:
Any medical condition to be aware of:
Signature: / Date:
Tel number: / Email Address

Print, Fill in & Sign, Scan and email back to

Waiver must be completed prior to Race Day, November 10th