LANEY
SURF CLUB
Name_____________________________________________________Age________
Address______________________________________________________________
City______________________________State__________________Zip_________
Phone____________________Emergency
Contact______________________
This
activity is in no way officially affiliated with any school-sponsored
event. This is an activity planned by,
informally organized by, and run by students in a student club. Therefore, it is your responsibility to
inspect the activity site and assure yourself that the area is safe for surfing
prior to paddling out.
This
release bars your rights to recover damages in the case of an accident injuring
you. Read this carefully before
signing.
“I will
not surf during this session unless I am satisfied that the area is safe for
surfing. I voluntarily agree to assume
all risks incident to the sport of surfing.
I fully understand and comprehend the dangers of surfing created by
sharp edges and the fins along with the natural buoyancy of a surfboard among
the powerful forces of the ocean and swells.
With full knowledge, comprehension and understanding of these dangers, I
voluntarily accept and assume all risks involved in the spirit of surfing. In consideration of your acceptance of my
participation, I intend to be legally bound hereby, for myself, my heirs,
executors and administrators, hold harmless and release and forever discharge
the Laney Surf Club, Laney High School and anyone connected with this informal
activity, from all liabilities for injuries and damages whatsoever.”
Student
signature___________________________________Date___________
“I HEREBY CERTIFY that I am the parent
or guardian of the surfer named above, and do hereby give my permission without
reservation and with full understanding and comprehension of the foregoing
agreement to hold the aforementioned organization and government entities
harmless of any and all liabilities including such injuries which are alleged
to have occurred as a result of negligent failure of the student clubs’ members
to properly supervise contestants in the course of this activity.”
Parent/Guardian
Signature__________________________Date__________
This form must be signed by a parent in
order to be considered for surfing!