Parent/Emergency Contact #1/ Información del Padre/Guarda primaria #1

Parent/Emergency Contact #2/ Información del Padre/Guarda primaria #2

Medical Information / Información médica

Code of Conduct

RVA Paddlesports River Leadership program aims to empower youth into independence and self-ownership. With this comes the responsibility of group contribution, mature decision making skills, and the ability to give and receive feedback. We expect participants to practice self-awareness and selflessness throughout the duration of the event. Foul language, lewd behavior, and the use of inappropriate substances are not tolerated. Staff reserve the right to make decisions on behalf of the group if a participant’s actions are deemed inappropriate. I understand the expectations needed by me from staff and fellow leaders and agree to abide by the guidelines listed above.

RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT

Organization Name: RVA Paddlesports (the “Host”) Chester, VA. In consideration of being allowed to participate in any way in the program, related events, and activities, and use of equipment, 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 official immediately.

4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY

RELEASE, INDEMNIFY, AND HOLD HARMLESS the Host, its officers, officials, agents and/or employees, other participants, sponsors, advertisers, and if applicable, owners and lessors 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.

Health Statement

I will notify the Host ownership or employees if I suffer from any medical or health condition that may cause injury to myself, others, or may require emergency care during my participation.

Media Statement

By signing below, I hereby grant and convey to RVA Paddlesports, all right, title and interest in

and to record my name, image, voice, or statements including any and all photographic images and video or audio recordings made by RVA Paddlesports. Permission is also granted for the use of my image in a non-exclusive basis throughout the world in perpetuity on all forms of media and the internet by RVA Paddlesports, local tourism offices, and any other entity RVA Paddlesports deems appropriate.

Venue

The Venue of any dispute that may arise out of this agreement or otherwise between the parties to which the Host or its agents is a party shall be either the Chester, VA Justice Court, or the County or State Supreme Court in Chesterfield County, VA.

I HAVE READ THIS 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.

HE LEÍDO ESTE ACUERDO DE LIBERACIÓN DE RESPONSABILIDAD Y ASUNCIÓN DE RIESGO, ENTIENDO COMPLETAMENTE SUS TÉRMINOS, ENTIENDO QUE HE RENUNCIADO A DERECHOS SUSTANCIALES AL FIRMARLO Y LO FIRMO LIBRE Y VOLUNTARIAMENTE SIN NINGÚN INCENTIVO.