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?No ?Yes If yes, please describe:_____________________________ Do you have any other concerns? ?No ?Yes If yes, please describe:__________________________ PARENT/GUARDIAN INFORMATION PARENT/GUARDIAN NAME: ________________________________________________________________________ ADDRESS: ______________________________________________________________________________________ CITY: ____________________________________________STATE: ________ZIP: __________________________ HOME PHONE: _______________________________________WORK PHONE: _____________________________ CELL PHONE: _________________________________E-MAIL: ____________________________________________ EMERGENCY CONTACTS (IN ADDITION TO PARENT/GUARDIAN OR IF DIFFERENT THAN PARENT/GUARDIAN) EMERGENCY CONTACT 1: _____________________________ PHONE: _____________________________________ EMERGENCY CONTACT 2: _____________________________ PHONE: _____________________________________ EMERGENCY CONTACT 2: _____________________________ PHONE: _____________________________________ ___________________________ X________________________________________ ______________________ PARENT/GUARDIAN (Print) SIGNATURE OF PARENT/GUARDIAN DATE Dates Enrolled:____________________________________________________________________________________ Founders Park Watersports ASSUMPTION AND ACKNOWLEDGEMENT AGREEMENT OF RISKS AND RELEASE OF LIABILITY AGREEMENT In consideration of being allowed to participate in any way in the Founders Park Watersports Summer Sailing Camp at the Village of Islamorada and its related events and activities, I the undersigned, acknowledge, appreciate, and agree that: The risks of injury from the activities involved in this program are significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and, 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; and, I willfully agree to take full responsibility in returning the rented equipment in the identical condition that it was signed out and comply with the stated and customary terms for the use of the rented equipment while participating. If, however, I observe any unusual significant hazard during my presence of participation, I will bring such to the nearest official immediately; and, I, for myself and on behalf of my heirs, assigns, personal representatives, and next of kin, HEREBY WAIVE AND RELEASE ANY AND ALL CLAIMS THAT THE UNDERSIGNED MAY HAVE AGAINST THE HOSTS, THE STAFF AND THE OFFICERS ARISING OUT OF THIS ACTIVITY, AND DO FURTHER AGREE NOT TO SUE OR TO BRING ANY CLAIM OR CLAIMS OF ANY NATURE WHATSOEVER AGAINST THE HOST ORGANIZATION OR ANY OF THE PERSONS AND OFFICERS NAMED, OR UNNAMED ABOVE WHO MAY BE ACTING ON THE HOST S BEHALF. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP THE SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. 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