Participation Registration and Waiver/Release

Participation Registration and Waiver/Release

All participants must register below and read and sign the Waiver and Release Form before participating in this event. Individual participants must evaluate their abilities, know all the risks associated with bicycle riding and water sports, and personally assume these risks. Remember to sign out before you leave!

Event __Pedal Paddle Ortega River 6 Bridges______Date_Oct. 1, 2016______

Location_Seminole Canoe and Kayak Club, 4619 Ortega Farms Cir, Jacksonville, FL 32210______

Released Parties: Seminole Canoe and Kayak Club, Florida Sea Kayak Association, Lake Shore Bicycles

and Fitness, and Event Leader Susan Poole

Participant Registration

PRINT Name / Phone Number / Emergency Contact
Name and Phone / Pedal / Paddle / TIME completed
Poole, Susan / 904-608-8563 / David Poole
904-866-8563 / √ / √

Waiver and Release Form

Event __Pedal Paddle Ortega River 6 Bridges______Date_ Oct. 1, 2016______

Location_Seminole Canoe and Kayak Club, Jacksonville, FL ______Miles Pedal/Paddle _15 / 8_

Released Parties: Seminole Canoe and Kayak Club, Florida Sea Kayak Association, Lake Shore Bicycles and Fitness, andEvent Leader Susan Poole

By signing this form for myself, I understand, agree, warrant and covenant as follows: I acknowledge that cycling and kayaking/canoeing/standup paddle boarding can be a dangerous sport and thatI participate in this event at my own risk.

In consideration of my participation in the above-entitled event,I release, hold harmless, forever discharge, and indemnify, the Seminole Canoe and Kayak Club, Florida Sea Kayak Association, Lake Shore Bicycles and Fitness, their members, officers, co-sponsors, and Event Leader Susan Poole (the “Released Parties”) fromany and all liability claims, losses, cost, expense, or attorneys’ fees and legal costs arising directly or indirectly from any accident or omission of anysuch person or organization, including intentional or negligent acts or omissions of the Released Parties. This includes all claims known andunknown, foreseen and unforeseen of bodily injury, personal injury, and loss of life. If any provision of this release and waiver, for any reasonand to any extent, is determined by a court of competent jurisdiction, to be invalid or unenforceable, neither the remainder of this release andwaiver nor the application of the provision to other persons, entities or circumstances shall be affected thereby, but instead shall be enforced to themaximum extent permitted by law.

Each club member, guest or non-member participant agrees to accept personal responsibility for his or her safety and the safety of minors accompanying such persons. Participant shall determine that he/she (and any accompanying minors) has the ability and knowledge to safely complete the activities undertaken.

Each participant agrees to assume all responsibility for his/her own vehicles and equipment, to provide necessary helmet, lifejacket, shoes, first aid supplies, water, food, suitable clothing for the weather to be encountered, and all other items necessary for safe completion of the activity.

All participants arerequired to wear properly fitted bicycle helmets while riding bicycles and U.S. Coast Guard Approved personal flotation devices while paddling water craft. Each participant further agrees to comply with all Federal and State traffic laws and boat safety regulations.

I have read this document and understand its contents, the risks involved and the legal implications and agree to abide by its terms and conditions during the period of my participation in this event.

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Waiver and Release Form (continued)

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