Loading...

Summa Love Surfing & Yoga LLC Registration / Waiver Form

SUMMA LOVE SURFING & YOGA LLC - RELEASE OF LIABILITY, WAIVER, AND ASSUMPTION OF RISK AGREEMENT CAUTION: DO NOT SIGN THIS DOCUMENT WITHOUT READING IT IN ITS ENTIRETY AND CAREFULLY. BY SIGNING THIS DOCUMENT, YOU GIVE UP IMPORTANT LEGAL RIGHTS! SURFING IS AN ATHLETIC ACTIVITY, THE PARTICIPATION IN WHICH INVOLVES VARIOUS RISKS. PLEASE READ AND UNDERSTAND THIS DOCUMENT. THIS IS A LEGAL DOCUMENT. MY SIGNATURE IS MY ACKNOWLEDGMENT OF THE CONTENTS OF THIS CONTRACT. SAFETY IS ALWAYS #1 FOR US. OUR STUDENTS HOLD OUR HIGHEST PRIORITY FOR SAFETY WITH ALL SPORTS WE INSTRUCT. I WILL NOT SIGN THIS DOCUMENT UNLESS I FULLY UNDERSTAND AND AGREE TO BE BOUND BY ITS CONTENTS.

I, the undersigned, being an adult, (or a minor on whose behalf a parent or legal guardian is signing this document) (hereafter "I" or "me"), acknowledge that:

1) I Know How To Swim and To Maintain Buoyancy In Open Water, and I Am In Good Health: I can maintain my head above water when my feet do not make contact with the bottom for extended periods of time. Likewise, I am in good physical and mental health, I am not under the influence of any drugs, alcohol, or other substances which may impair my swimming skills or my ability to take and follow instructions. I am not pregnant nor am I suffering from any spinal or skeletal defect, hearing, vision or balance impairment or other physical impairment. I understand that the foregoing representations as to my physical condition are being relied upon by SUMMA LOVE SURFING & YOGA LLC. I hereby agree to follow all rules, regulations, and instructions of SUMMA LOVE SURFING & YOGA LLC while participating in this class, lesson, or while renting equipment from SUMMA LOVE SURFING & YOGA LLC.

2) I Acknowledge That Surfing May Be Dangerous and I Accept and Assume Such Risk: I am aware that open water activities in general, and surfing specifically, involves inherent risks. I may damage my belongings, get hurt, get injured, become ill, drown, or even die. I further acknowledge that I have voluntarily chosen take surfing lessons from SUMMA LOVE SURFING &YOGA LLC, or if the individual taking such lessons or renting equipment is a minor, I have, as the minor's parent or legal guardian, voluntarily consented to such minor taking of such lessons,or renting equipment. I know and fully understand that water sports and surfing is a dangerous outdoor activity in an uncontrolled natural environment with inherent risks and hazards, where serious accidents can occur, participants can sustain property damage, injuries, illness and even die. I acknowledge and willingly and voluntarily assume all risks and hazards in surfing and beach related activities in all phases of these activities from the training sessions until the conclusion of the class, lesson, or equipment rental period, including, but not limited to those involving, (1) loss of control of the surfboard, malfunction of the surfboard, falls from the surfboard, collision with other participants, equipment, other surfboards, rocks, and any other man made or natural obstacles, whether obvious or not; (2) judgment, decision making and conduct of the instructors; (3) submersion in water, drowning; (4) encounters with animals, marine life, plant life, rocks and insects; (5) exposure to outdoor ocean environment, bacteria or microbes, extreme temperatures, sun, and inclement weather, including travel by foot or vehicle in any way related to this activity; (6) assistance in lifting and /or carrying surfing equipment; (7) rescue-related injuries; and (8)unavailability of immediate and appropriate medical attention in case of injury. I understand and acknowledge that the above list is not meant to be complete orexhaustive, and that other unforeseen and unanticipated risks, known or unknown, may also exist and result in damage, injury, illness, disease, or death.

3) I Waive My Right To Sue SUMMA LOVE SURFING & YOGA LLC: In consideration for SUMMA LOVE SURFING & YOGA agreeing to provide me with equipment or surfing instructions and/or allowing me to participate in this class or lesson, I agree that I shall not make a claim or bring any legal action against, sue, or hold responsible, City of Long Branch, SUMMA LOVE SURFING & YOGA LLC, its owner, officers, agents, employees, associates, representatives, or expect, require, or pursue them, to be held accountable for any damages. I voluntarily agree to release, discharge, and hold harmless SUMMA LOVE SURFING &YOGA LLC from and against any and all claims of liability, even those arising out of their negligence, fault, recklessness, or any other act or mission which causes me damages, illness, injury, disease, or death, of any nature in any way connected with my participation in this activity. I also expressly agree to release and discharge SUMMA LOVE SURFING & YOGA LLC from any act or omission, excluding acts of wanton or gross negligence, in rendering or failing to render any type of rescue,emergency or medical services.

4) Indemnity: I further agree, to hold harmless, defend, and indemnify SUMMA LOVE SURFING & YOGA LLC and City of Long Branch, from all defense costs, including attorney's fees incurred in connection with any claims arising from the activities anticipated herein, including but not limited to those for bodily injury, wrongful death, or property damage, whether caused by or sustained by any minor under 18 years of age on whose behalf I am signing, or which I may have caused to spectators or other third parties, whether negligent or not, in the course of my participation in this activity.

5) Permission to Obtain Medical Assistance: In the event of any injury, illness, emergency, accident or other harm sustained by me (or by the minor on whose behalf I am signing this document), I hereby give SUMMA LOVE SURFING & YOGA LLC permission to obtain Medical Assistance, in which event I hereby make the same releasesand waivers in SUMMA LOVE SURFING & YOGA LLC's favor as I have otherwise made in this agreement in connection with any such medical assistance sought or not sought. In addition, the expenses for any such medical emergency shall be my sole responsibility and not that of SUMMA LOVE SURFING & YOGA LLC.

6) Promotional Use of Images: I hereby agree that SUMMA LOVE SURFING & YOGA may use film or photographic records of this surfing class or lesson for its promotional and/or commercial purposes without compensation to me, and I consent to the use of my name and likeness for such use in any media now known or not known.

7) I HAVE READ THIS DOCUMENT IN ITS ENTIRETY AND IT IS MY INTENTION THAT IT BE BROADLY CONSTRUED IN FAVOR OF SUMMA LOVE SURFING & YOGA LLC IN THEEVENT OF ANY AMBIGUITIES,WHICH SHALL BE RESOLVED IN SUMMA LOVE SURFING & YOGA LLC'S FAVOR. I UNDERSTAND THAT I AM ASSUMING ALL THE RISKS INHERENT IN THIS SURFING ACTIVITY, AND THAT I MAY BE INJURED, BECOME ILL, OR EVEN DIE AS A RESULT OF SURFING. I UNDERSTAND THAT THIS IS A RELEASE OF ANY AND ALL CLAIMS. I UNDERSTAND THAT THIS IS THE ENTIRE AGREEMENT BETWEEN ME AND SUMMA LOVE SURFING & YOGA LLC, AND THAT NO REPRESENTATIONS HAVE BEEN MADE TO ME BY SUMMA LOVE SURFING & YOGA LLC OUTSIDE OF THIS AGREEMENT. I VOLUNTARILY SIGN MY NAME AS EVIDENCE OF MY ACCEPTANCE OF ALL THE PROVISIONS IN THIS RELEASE AND MY AGREEMENT TO BE BOUND BY THEM.

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.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Exact dates of camp?

Start Date *

End Date *
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!