Volunteer Waiver

This form must be completed before any participation is allowed.
Please read and be certain you understand the implications of signing below.

Activity or Event Organizer: Three Rivers Waterkeeper; including its members, officers,
directors, volunteers, employees, agents, contractors, servants, assigns, licensee’s successors in
interest, and legal representatives.

Activity or Event Description: Any and all activities; including travel to and from the
Activity when travel is facilitated or provided by the Sponsor.

RISK OF INJURY OR DEATH. Sponsor conducts outdoor events and activities that may involve kayaking, canoeing, boating, swimming, floating, fishing, hiking, water sampling, and other outdoor events and activities that primarily take place outdoors and on or near water. Many of these events and activities have significant inherent risks of serious injury and/or death, including but not limited to drowning; near-drowning; sprains; strains; fractures; heat and cold injuries, including burns, heat-related illness and hypothermia; over-use syndrome; injuries involving the acts or omissions of other participants or vehicles; animal or aquatic life attacks, bites, and/or stings; contact with poisonous or irritating plants or animals; falling from heights; heart attack; infections and/or injuries from water contamination or other environmental contaminations, including but not limited to diseases from exposure to fecal contaminated water or slurry; dismemberment; permanent paralysis; and/or death. While particular rules, equipment and/or personal discipline may reduce this risk, the risk of serious injury and/or death does exist. If I intend to use a watercraft in connection with the event, be it my own, rented or borrowed, I understand the risks related to the acquisition and usage of such a vessel, including to but not limiting to weather, tides, water movement, watercraft operation, collisions, water temperature, sun exposure, swimming, and rescue efforts. I understand the description of these risks is not complete and that unknown or unanticipated risks may result in injury, illness or death. Despite the risks, I still choose to participate in this Activity.

INCLEMENT WEATHER. The Sponsor and its affiliates reserve the right, in their sole determination, to postpone, cancel or modify the Activity due to weather conditions or other factors beyond their control that might affect the health and/or safety of participants. As a participant, I understand that weather may change even during the Activity and I understand the risk and danger that those changes may present to my health and safety, including but not limited to all of the risks described in the paragraph above.

ACT RESPONSIBLY. I understand the Activity may be inherently dangerous. I recognize my responsibility to inspect the equipment and facilities utilized, to exercise good judgment, to act responsibly, and to obey all of the Sponsor’s guidance, instructions and warnings. I understand that I need to follow all applicable laws, rules, and regulations contained in state law under: Pennsylvania Administrative Code, Title 58, Part II, Subpart C.

RELEASE OF LIABILITY. I, for myself, my heirs, executors, administrators, assigns, or personal representatives ((hereinafter collectively, "Releasor," "I" or "me"), which terms shall also include Releasor's parents or guardian if Releasor is under 18 years of age) will not sue the Sponsor. I forever release the Sponsor from any and all liability for injury. I will indemnify and hold harmless the Sponsor for any loss, liability, damage, or cost of any kind that may occur as a result of the injury. I release all liability even if I contend that my injuries are wholly or partly the result of negligence or other conduct on the part of the Sponsor for which a release is not
contrary to public policy. I voluntarily assume the risk of injury or even death while participating in the Activity. I shall assume all risk of and responsibility for, and agree to indemnify, defend, and hold harmless Sponsor and affiliates from and against any and all claims, demands, suits, actions, recoveries, judgments and costs and expenses, including attorney fees, in connection therewith on account of the loss of life, or injury or damage to the person, body or property of any person or persons whatsoever, which shall arise from or result directly or indirectly from my participation in the Activity that is the subject of this Liability Waiver and Release.

EMERGENCY MEDICAL CARE. I voluntarily assume the risk of injury or even death while participating in the activity. If I am injured, I authorize Sponsor to provide emergency first aid and for any medical or first aid personnel to provide medical care until such time as I or someone authorized by law (i.e. my medical care power of attorney) is able to act on my behalf. I consent to the administration of first aid and other medical treatment and related services, including evacuation/transport, in the event of injury or illness in connection with participation in the Activity and hereby release and indemnify Sponsor from any and all liability or claims arising out of such treatment and/or services. I acknowledge that the Sponsor shall have no duty, obligation or liability arising out of the provision of, or failure to provide, medical treatment. I give permission to authorized personnel to carry out such emergency diagnostic and therapeutic procedures as may be necessary for me, and also permit such treatment procedures to be carried
out at and by the local hospital(s) for me in the event of an emergency. I understand that any medical expenses will be billed directly to me or my insurance company.

This Waiver and Release of Liability Form (“Release Form”) shall be construed in accordance with the laws of Pennsylvania. This Release Form shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.

PHOTO RELEASE. I agree to let my photo be taken by any member or affiliated party at the Activity. I authorize Sponsor to produce, reproduce, broadcast, and otherwise use photos, videos, and other depictions, likeness or images of me, in any media form in connection with my attendance at or participation in the Activity, without compensation, for an unlimited duration.

PARTICIPANT DETAILS

* Indicates required field

Name *

First

Last

Birthdate (if a minor): *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Emergency Contact Name *

First

Last

Emergency Contact Relation *

Emergency Contact Phone Number *

I have carefully read this Participant Waiver and Release of Liability. I am 18 years of age or more or I am signing as a parent or guardian of a minor child with the consent of the other parent or guardian (if any). I understand that I may be giving up the rights of my child and spouse to sue as well as giving up my own right to sue. I have read and understood the contents of the volunteer agreement above and by submitting this form, I am intending to be legally bound to the volunteer agreement.

Date *

Printed name of person signing for a minor *

First

Last

Submit