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Today's Date: April 27, 2024

PLEASE READ AND FILL OUT THIS FORM COMPLETELY AND RETURN PRIOR TO YOUR PROGRAM

In agreeing to voluntarily participate in any way in the programs of Cascadia SUP, LLC (herein referred to as CSUP), I recognize that certain inherent risks and dangers exist.

I understand that CSUP, its staff, private contractors, and other program participants shall assume no responsibility or liability for me for accident, illness, injury, or loss or damage of personal property caused either by negligence orrisks inherent to the activities of the program. I knowingly and willingly acknowledge and assume all risks in connection with the activities of the program.

I, for myself and on behalf of my heirs, assigns, personal representatives, and next of kin, hereby hold CSUP harmless for any and all liability, action, claims, and damage of every kind.

I will comply with the stated terms and conditions for participation. If I observe any unusual significant hazards during my presence or participation, I will remove myself from participation and bring it to the attention of CSUP staff immediately upon occurrence.

I hereby grant permission to all of the foregoing to use any photographs, motion pictures, recordings, or any other record of this event for any legitimate purpose.

I hereby grant permission to Cascadia SUP to place a secure hold on my credit card in the case that I either do not return ALL rented equipment (Charge equal to the full retail price of the unreturned/lost equipment) or if the equipment I do return is damaged and in need or repair ($30 repair charge).

AUTHORIZATION OF EMERGENCY MEDICAL CARE

I am aware of my general condition and affirm that I am fit to participate in any activities required for participation in this program. I will fully disclose any relevant medical information to CSUP staff and will engage in all prescribed activities except for those noted by me and/or my examining physician. In the event that I am rendered unable to communicate by an emergency or accident, I authorize and request such medical services as may be necessary and further agree to accept financial responsibility for same.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT AND FULLY UNDERSTAND ITS TERMS. MY SIGNATURE ON THE DOCUMENT IS ALSO INTENDED TO BIND MY HEIRS, REPRESENTATIVES, EXECUTORS, OR ADMINISTRATORS.

 

 

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
FOR PARENTS/GUARDIANS' OF PARTICIPANTS OF MINORITY AGE: This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of CSUP, and for myself, my heirs, assigns, and next of kin, I release and agree to hold harmless CSUP from any and all liabilities incident to the minor child's involvement or participation in CSUP programs, related events and activities to the fullest extent permitted by law.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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