Registration Form for Beginners Class
Class Date:______________
Name:________________________________
Address:_________________________________________
City:__________________ State:_______ Country:________ Zip:__________
Phone:(____)_________________
Email:_____________________________
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WAIVER FORM
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IN CONSIDERATION of being given the opportunity to participate in any Miami Beach Watersports Center, Inc., Ronald W. Shane Watersports Center, Miami Beach Rowing Club or City of Miami Beach activities, I, for myself, my personal representatives, assigns, heirs, and next of kin:
1. ACKNOWLEDGE, agree and represent that I understand the nature of Rowing Activities, both on water and land based, and that I am qualified, in good health, and in proper physical condition to participate in such Activity.
2. FULLY UNDERSTAND that: (a.); ROWING ACTIVITIES INVOLVE RISKS AND DANGERS of serious bodily injury, including permanent disability, paralysis and death ("Risks”); (b.) these Risks and dangers may be caused by my own actions, or inactions, the actions or inactions of others participating in the Activity, the condition in which the Activity takes palace, or the negligence of the Releases names below; (c.); there may be other risks and social and economic losses either not known to me or not readily foreseeable at this time; and I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES I incur as a result of my participation in the Activity.
3. AGREE AND WARRANT that I will examine and inspect each Activity in which I take part as a member of the Club and that, if I observe any condition which I consider to be unacceptably hazardous or dangerous, I will notify the proper authority in charge of the Activity and will refuse to take part in the Activity until the condition has bee corrected to my satisfaction.
4.
HEREBY RELEASE, discharge, and covenant not to sue USRowing, the Club,
their administrators, directors, agents, officers, volunteers and employees,
other participating regatta organizers, any sponsors, advertisers, and if
applicable, owners and lessors of premises, on which the Activity takes place,
(each considered on of the Releasees herein) from all liability, claims,
demands, losses or damages on my account caused or allege to be caused in
whole or in part by the negligence of the Releasees or otherwise, including
negligent rescue operations; and I further agree that if, despite this release
and waiver of liability, assumption of risk, and indemnity agreement, I, or
anyone on my behalf, makes a claim against any of the Releasees, I WILL
INDEMNIFY< SAVE AND HOLD HARMLESS each of the Releasees, from any
litigation’s expenses, attorney fees, loss, liability, damage, or cost which
any may incur as a result of such claim.
I have
read this agreement, fully understand its terms, understand that have given up
substantial rights by signing it and have signed it freely and without any
inducement or assurance of any nature and intend it be a complete and
unconditional release of all liability to the greatest extent allowed by law
and agree that if any portion of this agreement is held to be invalid, the
balance, notwithstanding, shall continue in full force and effect.
______Initial
here acknowledging that you can swim and stay afloat in deep water for 10
minutes.
Participant’s
Signature (only if age 18 or over)
(Fees
are non-refundable)
Date: / /
PARENTAL CONSENT
AND I, the minor’s parent and/or legal guardian, understand the nature of rowing activities and the minor’s experience and capabilities and believe the minor to be qualified to participate in such activity. I hereby release, discharge, covenant not to sue, and AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS each of the Releasees from all liability, claims, demands, losses, or damages on the minor’s account caused or alleged to be caused in whole or part by the operations, and further agree that if, despite this release, I, the minor, or anyone on the minor’s behalf makes a claim against any of the above Releasees, I WILL INDEMNIFY, SAVE, AND HOLD HARMLESS each of the Releasees from any litigation expenses, attorney fees, loss liability, damage, or cost any may incur as the result of any such claim.
Printed Name of
Parent/Guardian:________________________________
Address:_________________________________________
City:__________________ State:_______ Country:________ Zip:__________
Phone:(____)_________________
Email:_____________________________
Parent/Guardian
Signature:
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Date:
Type of Payment: Payment must be paid in advance to secure a space in the class.
Check:____ Cash:____
For cash/check, please submit in person to
Elaine Roden at the Watersports Center's Club office before the class date.
Credit Card (Visa & Mastercard Only):____
Credit Cards may be
submitted in person at the Watersports Center or faxed to 305.861.8841. Make sure to bring your credit
card to class on the first day.
Name on Card:_________________________
Type:__________ Number:_________________________
Expiration Date: _______
Signature:_________________________________