Waiver (Required)
RELEASE OF LIABILITY
PLEASE READ BEFORE SIGNING
IF YOU CANNOT SWIM, PLEASE LET US KNOW!
Organizations: Apex Aqua Adventures LLC and Pine Island Pedal Kayaks LLC
Participant Name:__________________________________
In consideration of being allowed to participate in any way in the activity, I the undersigned, acknowledge, appreciate, and agree that:
1. The risk of injury, paralysis, and/or death is possible though very unlikely.
2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, BOTH KNOWN AND UNKNOWN, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES and assume full responsibility for my participation.
3. I willingly agree to comply with the terms and conditions for participation. If I observe an unusual significant hazard during my presence or participation, I will remove myself from participation and bring such attention to the owners, guides, or other employees present immediately.
4. I, for myself and on behalf of my heirs, assignees, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS THE RELEASEES. The RELEASEES are Apex Aqua Adventures LLC and Pine Island Pedal Kayaks and consist of their owners, officers, agents, employees, other participants, sponsors, advertisers, and owners and lessors of premises used to conduct the activity, from any and all claims, demands, losses, and liability arising out of or related to any injury, disability or death I may suffer, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.
5. The RELEASEES are not responsible for lost or stolen items. Please secure your cell phone to your person. If you do not have a device to secure your cell phone, please ask.
6. I understand that if I cause damage to kayaks, pedal drives, or motors, I will be responsible for up to $5000 worth of damage.
I HAVE READ THE RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
I agree that any film or photographs of me/us, as participants, become the property of Apex Aqua Adventures LLC and Pine Island Pedal Kayaks LLC and may be used for promotional or commercial purposes.
X______________________________ ____________
Participant’s Signature Date
_______________________________ __________________________________________
Phone # E-mail
Apex Aqua Adventures LLC & Pine Island Pedal Kayaks LLC (aka Pine Island Kayaks)
3339 Stringfellow Rd., St. James City, FL 33956 www.pineislandkayaks.com
REPLACEMENT COSTS DUE TO NEGLIGENCE or LOSS:
Hobie Mirage Lynx Kayak $2,900
Hobie Mirage Pedal Drive $800
Hobie Mirage 180 Pedal Drive $1,000
Hobie Mirage Lynx Rudder $200
Hobie Mirage Lynx Seat $430
Hobie H-Crate $180
Hobie Paddle $90
Bungee Dock Line (rope) $18
Phone Holder $15
Belted Life Jacket $65
I agree to use the credit card on file for charges due to negligence or loss. I will be informed before any charges are made to my card.
Name on Card
Credit Card #
Expiration
CVV
Zip Code
*All prices exclude tax* Signature Date, I the undersigned, acknowledge, appreciate, and agree that:
1. The risk of injury, paralysis, and/or death is possible though very unlikely.
2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, BOTH KNOWN AND UNKNOWN, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES and assume full responsibility for my participation.
3. I willingly agree to comply with the terms and conditions for participation. If I observe an unusual significant hazard during my presence or participation, I will remove myself from participation and bring such attention to the owners, guides, or other employees present immediately.
4. I, for myself and on behalf of my heirs, assignees, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS THE RELEASEES. The RELEASEES are Apex Aqua Adventures LLC and Pine Island Pedal Kayaks and consist of their owners, officers, agents, employees, other participants, sponsors, advertisers, and owners and lessors of premises used to conduct the activity, from any and all claims, demands, losses, and liability arising out of or related to any injury, disability or death I may suffer, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.
5. The RELEASEES are not responsible for lost or stolen items. Please secure your cell phone to your person. If you do not have a device to secure your cell phone, please ask.
6. I understand that if I cause damage to kayaks, pedal drives, or motors, I will be responsible for up to $5000 worth of damage.
I HAVE READ THE RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
I agree that any film or photographs of me/us, as participants, become the property of Apex Aqua Adventures LLC and Pine Island Pedal Kayaks LLC and may be used for promotional or commercial purposes.
X______________________________ ____________
Participant’s Signature Date
_______________________________ __________________________________________
Phone # E-mail
Apex Aqua Adventures LLC & Pine Island Pedal Kayaks LLC (aka Pine Island Kayaks)
3339 Stringfellow Rd., St. James City, FL 33956 www.pineislandkayaks.com
FOR CHILDREN
RELEASE OF LIABILITYFOR PARENTS/GUARDIANS OF PARTICIPANT OF MINOR AGE(UNDER AGE 18 AT TIME OF PARTICIPATION)This is to certify that I, as parent/guardian with legal responsibility for the participant, do consent and agree to his/her release as provided above of all the RELEASEES, and for myself, my heirs, assigns, and next of kind, I release and agree to indemnify and hold harmless the RELEASEES from any and all liability incidents to my minor child’s involvement or participation in these programs as provided above, EVEN ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.
X______________________________
Participant’s Name
X______________________________
Participant’s Name
X______________________________
Participant’s Name
X______________________________ ____________
Parent/Guardian Signature Date
X______________________________
Emergency Phone #
Apex Aqua Adventures LLC & Pine Island Pedal Kayaks LLC (aka Pine Island Kayaks)
3339 Stringfellow Rd., St. James City, FL 33956 www.pineislandkayaks.com