RELEASE OF LIABILITY & ASSUMPTION OF RISK AGREEMENT FOR: Cowgirl Camp at Little Wing Hollow, Good Time Paddling at Little Wing Hollow, and Little Wing Hollow Art & Nature Sanctuary
If registering by U.S. mail: You may fill out a hard copy of this agreement and mail it with your payment and registration information.
Send to: Little Wing Hollow Anessa Arehart 1450 Johnson Road Harrodsburg KY 40330
Registration will not be accepted unless terms of this agreement are accepted in full with payment. Name of Adult Participant (over 18) :_______________________ Today's Date_________________
If registering online: Clicking the online registration waiver box on the registration page serves as your digital signature and confirms your acceptance of the following terms on behalf of yourself, any minors in your party, and/or any additional participants you are registering:
In consideration of being allowed to participate in, in any way, in the programs, related events, and activities taking place at Cowgirl Camp at Little Wing Hollow, Good Time Paddling at Little Wing Hollow, and Little Wing Hollow Art & Nature Sanctuary, I the undersigned, acknowledge, appreciate, and agree that:
1.) The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death.
2.) I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation.
3.) I willingly agree to comply with terms and conditions for participation. If I observe any unusual significant hazard during my presence or participation, I will remove myself from participation, and bring such to the attention of the nearest Cowgirl Camp at Little Wing Hollow, Good Time Paddling at Little Wing Hollow, or Little Wing Hollow Art & Nature Sanctuary instructor, volunteer, or employee immediately.
4.) I, for myself, and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS Cowgirl Camp at Little Wing Hollow, Good Time Paddling at Little Wing Hollow, and Little Wing Hollow Art & Nature Sanctuary, its officers, officials, agents and/or employees, volunteers, instructors, other participants, sponsors, advertisers, and, if applicable, owners and leasors of premises used to conduct the event (RELEASEES), 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. Furthermore, I understand that by registering other participants/guests/minors they are automatically, knowingly, and willingly accepting all terms set forth in this agreement and are in compliant without hesitation, understanding all possible risks involved.
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, I FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT ON BEHALF OF MYSELF AND ANY GUESTS, PARTICIPANTS, OR MINORS LISTED DURING THE REGISTRATION PROCESS.
Adult Participantʼs Signature _______________________________ Date _______________ Emergency Phone # _____________________________________ ( ) I am 18 years old or older.
PARENTS/GUARDIANS OF PARTICIPANTS OF MINOR AGE (under age 18 at time of registration): This is to certify that I, as parent/guardian with legal responsibility for this 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 kin, I release and agree to indemnify and hold harmless the Releasees from any and all liability incidents to my minor childʼs involvement or participation in these programs as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by law.
Parent / Guardian Name (Over 18) ________________________________ Date _______________ Emergency Phone # _____________________________________ Parent/Guardian Signature: __________________________________ Today's Date_________________
Please check the box that you are assuming responsibility of all minors listed below: I'm over 18 years old and will be responsible for the following minor participants. ( ) Check box if over 18 and serving as guardian for minors listed below.
Minor Participant's Name: ____________________________________________ Minor Participant's Name: ____________________________________________ Minor Participant's Name: ____________________________________________