Participant Name (print clearly)________________________________
Sex: M____ F____ Birthdate___________________
Address:
City___________________State______ Zip
code_________
Home
phone_______________________ Work
phone_______________
Cell
phone___________________________
E-mail_______________________________ (for office use only)
Emergency
name to call_________________________________
Emergency phone_________________________________
Injuries
to participants in small watercraft programs may occur from risks
inherent in the sport or activity or from the participants own actions.
For examples, a sailboat boom can unexpectedly swing across the boat, hitting and injuring a head or other body part.
Injury
can happen to a body from placing stress on that body that it is not
prepared for; from accidents in learning or practising techniques; from
failing to follow training, safety or racing rules; from the use of
transportation to and from events and from the administration of first
aid. For example, I might slip and fall; I might be struck by a
part of a boat; my boat might capsize or I might be thrown overboard
into water that by the official US Coast Guard definition is "cold
water" and suffer hypothermia or be stung by, for example, a jelly
fish; my boat might hit another boat or an obstruction or the shore and
the collision injure me. The severity of any of these example
injuries can range from minor cuts and scrapes to muscle strain to
catastrophic injury or even death. I will be exposed to the
weather, including rain, wind, cold and sun and therefore I could
become ill through chill, sunburn, heat exhaustion or heat stroke.
In order to avoid injuries or illness, I will obey the directions
of my instructors and will follow all safety rules. I will wear
cold water clothing, wear a non-inflatable personal flotation device
(PFD), carry a water bottle and snacks in order to remain hydrated and
full of energy. I will tell my instructors about any limitations
or medical restrictions on my participation. In consideration for my
acceptance as a participant, I agree to assume the risks, release and
hold Camano Sail and Power, LLC, and Washington State Parks, their
sponsoring organizations and their employees, agents and volunteers
harmless from claims for injuries and damages, which may occur from or
as a result of my participation in the program. I agree that this
assumption of risk and release shall bind my heirs and my estate.
Participation
authorized, risks assumed and release granted. The authorizing
signature below acknowledges having read all of the statements above
and having asked for and received clarification or explanation if said
statements were not understood. Participant's signature required
plus the signature of a parent or guardian if the participant is
under 18 years of age.
_____________________________________
_________________________________________
Printed
name of Participant
Signature of Participant
Date_____________
_____________________________________
_________________________________________
Printed
name of Parent or Guardian
Signature of Parent or
Guardian
Date______________