Kayaking Program Digital Waivers – OceansOfHopeFoundation.org

Essential Eligibility Criteria (EEC) / Medical Self-Evaluation Form / Insurance Waiver / Release of Liability Waver & Media Release Form

Signature *

I acknowledge that I, or my minor child, meet the above essential eligibility criteria.

Name *

First

Middle

Last

Oceans Of Hope Foundation Kayak Program's Medical Self-Evaluation Form
(Required of all event/training session participants -guest & volunteers)

Paddlesports can be strenuous and involve inherent risk. If you have questions regarding your health and ability to safely participate please consult your physician. We ask for the following information to help ensure that you have a safe, enjoyable experience. Please use additional comments field if necessary.

Name *
First
Middle
Last

Address *

Email

Height *

Weight *

Date of Birth *

Can you seal your airway passage while under water? *
Yes
No
Partly
I Don't Know

Do you require any type of external neck support *
Yes
No
Partly
I Don't Know

Are you able to wear a properly fit life jacket (PFD) *
Yes
No
Partly
I Don't Know

Please describe your swimming ability: *

Please describe your canoeing / kayaking / rafting / other paddlesports experience. *

Allergies? *
Yes
No

Heart Disease? *
Yes
No

High Blood Pressure? *
Yes
No

Dislocations? *
Yes
No

Do you get cold easly? *
Yes
No

Allergic to insect bites or stings? *
Yes
No

Diabetes? *
Yes
No

Asthma? *
Yes
No

Are you pregnant? *
Yes
No

Allergic to any medications? *
Yes
No

Back Problems? *
Yes
No

Muscle spasms? *
Yes
No

Are you greatly affected by heat? *
Yes
No

Are you taking medications? *
Yes
No

Any side effects of medication such as sun sensitivity, increased thirst or fatigue? *
Yes
No

If you answered YES to any of the questions above please explain below:

Do you have a disability? If yes, please describe:

Do you have mobility impairment? If yes, please describe:

Do you have sensory impairment (sight, sounds or sensation)? If yes, please describe:

So that we can better understand your needs, please list any medical, physical, physical, psychological or emotional issues not mentioned above:

In case of Emergency - Please contact: *
First
Last

Day Phone# *

Other Number:

Relation:

Signature *

Name *
First
Middle
Last

All participants/guardians also agree to the terms of the Oceans of Hope Foundation's Insurance Waiver & Release of Liability and Media Release Form.

Participant/Volunteer's Name *
First
Last

Address *

Phone Number: *

Email:

Date of Birth: *

Male/Female *
Male
Female

Height: *

Weight: *

Emergency Contact: *

Emergency Contact Phone: *

In consideration of being allowed to participate in any way in the Oceans of Hope Foundation's programs, related events and activities, I and/or the minor participant, for myself, and on behalf of my heirs, assigns, personal representatives and next of kin, the undersigned: 1. Agree that prior to participating, I will inspect, or if a parent/legal guardian, I will instruct the minor participant to inspect the facilities and equipment to be used. If I believe, to the best of my ability, that anything is unsafe, I and/or the minor participant will immediately advise the Oceans of Hope Foundation of such condition(s) and refuse to participate.

2. Acknowledge and fully understand that I and/or the minor participant will be engaging in activities that involve risk of serious injury. including permanent disability and death. I understand that severe social and economic losses which might result only from my own actions, inactions, or negligence of others, rules of play or the condition of the premises or any equipment used. Further, that there may be other risks not known to me or not reasonably foreseeable at this time.

3. Assume all the foregoing risks and accept personal responsibility for the damages following such injury, permanent disability or death.

4. Release, waive, discharge and covenant not to sue the Oceans of Hope Foundation, its affiliated clubs, their representative administrators, directors, agents, coaches and other employees of the organization, other participants, sponsoring agencies, sponsors, advertisers, their heirs and if applicable, the owners and and leasers of the premises used to conduct the event, all of which are hereinafter referred to as "releases," from demands , losses or damages on account of injury, including death or damage to property, caused or alleged to be caused in whole or in part by the negligence of the releasee or otherwise.

I/WE HAVE READ THE ABOVE WAIVER AND RELEASE, UNDERSTAND THAT I/WE HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, HAVE NOT CHANGED IT ORALLY AND SIGN IT VOLUNTARILY.

Signature *

Participant Name *
First
Middle
Last

This is to certify that I, as a parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of the Releasees and for myself, my heirs, assigns and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my minor child's involvement or participation in these programs as provided above, EVEN IF ARISING FROM THEIR NEGLIGENCE.

Signature

Parent/Guardian's Name
First
Middle
Last

MEDIA RELEASE FORM

I herby authorize and give my full consent to the Oceans of Hope Foundation to copyright and/or publish any and all photographs, videos or film footage in which I appear while attending an Oceans of Hope Foundation event. I further agree that the Oceans of Hope Foundation may transfer, use or cause to be used, these photographs, videos or film footage for any exhibitions, public displays, publications, commercials, artwork, advertising and television programs without limitations or reservations.

Signature *

RELEASE AND HOLD HARMLESS AGREEMENT
BATTLE ISLAND ADVENTURE CLUB, L.L.C

I understand that my family's participation and/or involvement in the Battle Island Adventure Club, L.L.C. carries with it the potential for certain risk, some of which may not be reasonably foreseeable. I further acknowledge that these risk could cause me, or others around me, harm, including, but not limited to, bodily injury, damage to property, emotional distress, or death. I am a willing participant in the Battle Island Adventure Club L.L.C. and any programs sponsored by the club. By signing this agreement, I agree to release, indemnify, and hold harmless the Battle Island Adventure Club L.L.C, as well as all its employees, agents, representatives, successors, etc. from all losses, claims, theft, demands, liabilities, causes of action, or expenses, known or unknown arising out of my participation in, attendance at, etc. all programs and activities with the Battle Island Adventure Club, L.L.C

Signature *

Name *
First
Middle
Last

Enter Today's Date: MM/DD/YYYY *

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