In consideration of being allowed to participate in any way in Rockaway Community Canoe Club athletics/sports program, and related events and activities, the undersigned, for him/herself, his/her personal representatives, heirs, next of kin: 
1. Agrees that the parent(s) and/or legal guardian(s) will instruct the minor participant that prior to participating he/she should inspect the facilities and equipment to be used, and if the participant believes anything is unsafe, he /she should immediately advise the Rockaway Community Canoe Club or supervisor of such condition(s) and refuse to participate. 
2. Acknowledges and fully understands that each participant will be engaging in activities that involve risk of serious injury, including permanent disability and death, and severe social and economic losses to person or property which might result not only from his/her own actions, inactions or negligence, but also the actions, inactions or negligence of others, the rules of play or the condition of the premises or of any equipment used. Further, that there may be other risks not known to us or not reasonably foreseeable at this time. 
3. Assumes all the foregoing risk and accepts personal responsibility for any and all loss, liability, damages or costs following such injury, permanent disability or death. 
4. Releases, waives, discharges and covenants not to sue the Rockaway Community Canoe Club, its affiliated clubs, their respective administrators, directors, agents, coaches, and other employees or agents of the organization, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used to conduct the event, all of which are hereinafter referred to as "releasees," from any and all liability demands, losses or damages on account of injury, including death or damage to property, caused or alleged to be caused in whole or part by the negligence of the releasees or otherwise. 
5. Agrees to indemnify and save and hold harmless the releasees from any loss, liability, damage, or cost they may incur due to the presence of the undersigned in any way competing, officiating, observing, or working for, or for any purpose participating in this activity. 

THE UNDERSIGNED HAS READ THE ABOVE WAIVER, INDEMNIFICATION AND RELEASE, UNDERSTANDS THAT HE/SHE HAS GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND SIGNS IT VOLUNTARILY.

Parent or Guardian Signature Date:

Printed Name / Relationship of Parent or Guardian:

Printed Name of Minor:

Address of Minor:

City State Zip:

Phone Fax: