ASSUMPTION OF RISK AND RELEASE
FORM
Customer/Charteree/Auction
Winner Name______________________________________________
Address ____________________________________________________________________________
City___________________________State______________Zip_________________________
Phone,
Home_______________________ Phone,
Work/cell______________________________
E-mail______________________________________________(this
will not be shared)
Emergency name (1) to
call__________________________________
Emergency number
(1)______________________________________
Emergency name (2) to
call__________________________________
Emergency number (2)
to call________________________________
Sex M
F
Birthdate________________________
Putting out to sea
in, or working around a boat is inherently risky. Injuries to Clients, Charterees or Auction
Winners in
keel sailboat programs or in powerboat or sailboat charters or rentals for sailing,
fishing, crabbing, shrimping, sightseeing, leisure or other on-the-water
boating activities may occur from risks inherent in these activities, as for
example from working with tools, placing stress on the body that it has not
been prepared for; from accidents in learning or practicing techniques; from
failing to follow training, racing, or safety rules; from failing to follow the instructions or
warnings of the person in charge; from failure to use appropriate common sense
and practices while boating or fishing; from the use of transportation to and from
events and from the administration of first aid, CPR or the use of an AED
(automatic defibrillation device). Other
non-exclusive risks taken by going out on a boat include, for example, I might
slip and fall; I might be struck by a part of the boat or objects on shore; the
boat may capsize or sink; I might be thrown or fall overboard into cold water;
my boat may hit another boat or run into an obstruction or the shore, and the
collision injure or kill me; while fishing I might get pierced with a fishhook
or be otherwise injured by the equipment used for fishing, crabbing or
shrimping; I may be injured by the catch (e.g. crab, shrimp, fish) or by other
plant or animal inhabitants of the waters of Puget Sound. The
severity of the injury can range, for example, from minor cuts, scrapes, stings, piercings,
muscle strains or broken bones to catastrophic injury such as paralysis or even
death. I will be exposed to the weather, including rain, wind, cold and sun; I
might become ill through chill or suffer sunburn and heat exhaustion or
heatstroke. In order to minimize and
avoid injuries such as these I will obey the directions of the instructors or
the vessel's master or my employer and will follow all safety rules and will
not engage in behaviors that could either compromise my or other people's
safety, welfare,
the
vessel of any actions on the part of the boat, crew,
other passengers, other employees, independent contrctors working for
Camano Sail nd Power or volunteers, that make me uncomfortable,
sick or that otherwise compromise my comfort, health, pleasure and/or
safety.
(write in name of
referring business here, if applicable)__________________________________________________, from claims for
injuries, death or damages,
which may occur from or as a result of my participation in these boating
activities. I agree that this assumption
of risk and release shall bind my heirs and my estate.
Printed name of
Participant
Signature of Participant
Date
and if the Client, Charteree or Auction Winner is
under 18 years of age:
Printed name of
parent or guardian Signature
of parent or guardian
Date