POTOMAC RIVER SWIM KAYAKERS RELEASE AND WAIVER OF LIABILITY
INDEMNITY AGREEMENT AND ASSUMPTION OF RISK

I am aware that participation in Potomac River Swim activities is dangerous and physically demanding and involving risk of injury. The risks include, but are not limited to, injury, exposure to temperature extremes or inclement weather, accidents while traveling to and from activity sites and other risks that may not be known. I am also aware that weather and sea conditions are unpredictable and dangerous.

I am responsible for my own safety and well-being during events involving sea kayaking and related activities conducted under the auspices, sponsorship or leadership of the Potomac River Swim, and in transit to and from such activities.

I expect to assist my fellow paddlers and assigned swimmer to the best of my own personal skill and ability if they appear to need such assistance, but only so long as I can do so, in my own judgment, without significant danger to myself. I further understand that this does not imply any legal duty for me to do so.

I acknowledge that Potomac Swim volunteers who lead club activities, trips, or workshops are not professional leaders, guides or instructors, and should not be regarded as such. I agree that I am responsible for my safety when participating in activities, and should consider and evaluate my ability to handle the conditions present at all times.

In Consideration for being permitted to participate in these activities I AGREE TO:

RELEASE, WAIVE, DISCHARGE AND CONVENANT NOT TO SUE Potomac River Swim, Potomac River Swim directors and volunteers, all participants of Potomac River Swim (collectively referred to as RELEASEES), for ALL CLAIMS OF LIABILITY for injury, death, property damage or other loss, now or in the future, as a result of my participation in these activities or activities incidental thereto.

TO INDEMNIFY AND HOLD HARMLESS THE RELEASEES from all claims of liability for any injury, death, property damage or other loss I incur.

ASSUMPTION OF RISK: I acknowledge the dangers in the activities and I voluntarily ASSUME ALL RISKS, BOTH KNOWN AND UNKNOWN, AND ACCEPT FULL RESPONSIBILITY for injury, death, property damage or other loss. I am free of any medical condition that might create undue risk in myself or others who might depend upon me in these activities.

_________Initial here

Revised May 2010
In the event that I am injured during an activity of Potomac Swim, I give permission for activity participants to administer first aid and to seek medical assistance as deemed necessary. I intend that the releases, waivers and assumptions of risk contained in this agreement shall fully apply to any claim whatsoever on account of first aid treatment or service rendered to me during my participation in Potomac Swim activities.

I have carefully read BOTH SIDES (or pages, if someone failed to print the form on two sides) of this agreement and fully understand its contents. I AM AWARE THAT THIS IS A RELEASE AND WAIVER OF LIABILITY TO ALL RELEASEES. I understand and freely sign this agreement and agree that no oral representations, statements or inducements have been made apart from the foregoing agreement. This AGREEMENT shall bind my heirs, executors, assigns, legal representative and family members.

Name: Signed:___________________________ Date: June 4, 2011

Parent or Guardian, if Participant is less than 18 years old:

Name: Signed:___________________________ Date:

OTHER IMPORTANT INFORMATION
Emergency contact:
Name:
Phone:
Level of swimming ability:
Please describe any medical conditions that the trip leader should know about for your safety (e.g. diabetes, allergy to bee stings, asthma):