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Dan River Sojourn 2010 |
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Participants will be required to sign a form
with the following information: |
Assumption of Risk/Waiver
of Claim Date
PLEASE PRINT CLEARLY: I,__________________ ,
wish to participate in the Dan River Sojourn
2010 offered by the Dan River Basin
Association.
I understand that the above-mentioned
program involves activity that can be both
strenuous and physically demanding and could
result in my being physically injured. Such
injuries could include strained, sprained,
or torn muscles, ligaments and tendons,
broken bones, head or back injuries,
concussions and even loss of life. I
understand that this is only a partial list
of the injuries I might receive as the
result of engaging in this activity.
I understand the importance of following all
rules and regulations relating to this
activity, including the instructions of the
person or persons supervising this activity
and/or the requirements of the person or
entity responsible for the area where the
activity takes place. I agree to follow and
comply with all such rules, regulations,
instructions and/or requirements.
I have and will make use of a Personal
Flotation Device for each person in my boat.
I understand that it is important that I be
in good physical condition when I engage in
this activity, and I understand that it is
my responsibility to maintain an activity
level that is compatible with my physical
condition and skill level.
I hereby expressly assume the risk of any
physical injury or other loss that I might
sustain as the result of participating in
this activity. I further understand that
there may be a risk of injury traveling to
and from the area where the activity will
take place.
I also expressly waive and covenant not to
sue on any claim I might have against the
Dan River Basin Association, or any officer,
board member, or employee of the Dan River
Basin Association, or any volunteer, or the
owner(s) of any private property or
properties used in conjunction with this
activity, or the estate or representatives
of such person(s) for any personal injury or
loss I might sustain as the result of
engaging in any activity relating to this
program whether caused by negligence, breach
of contract or otherwise;
I understand that photographs may be taken
during this event. I grant to DRBA, its
representatives and employees the right to
take photographs of me and any minors in my
company in connection with this activity. I
authorize DRBA, its assigns and transferees
to copyright, use and publish the same in
print and/or electronically. I agree that
DRBA may use such photographs of me and any
minors in my company, with or without my
name, and for any lawful purpose, including,
for example, such purposes as publicity,
illustration, advertising, and Web content.
I have the following physical impairments or
medical conditions, including allergic
reactions:
I grant permission for the trip coordinator
to seek medical attention should the need
arise and parent/next of kin cannot be
reached by telephone.
In case of emergency, contact:
Name:_______________________
Address Phone _________________
PLEASE READ CAREFULLY BEFORE SIGNING
X_____________________________________________________
Signature of Participant Signature of
Parent/Guardian (If Participant Is Under 18)
________________________________________________________
Address City
State
Zip
Phone Email (for future
notices)________________________
Revised 4/2010
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