Loading...

Avalon Rotary Club Foundation 

Release of Liability/Assumption of Risk form

INFORMED CONSENT AND WAIVER OF RELEASE 


In consideration of permitting me, (Participant’s Name) to participate in scuba diving activities of the 42nd. Annual Avalon Harbor Underwater Cleanup, in the City of Avalon, the County of Los Angeles, and the State of California, on the 24th day of February 2024 (the “Event”): 

I hereby, voluntarily release, discharge, waive and relinquish any and all actions or causes of action for personal injury, property damage or wrongful death occurring to me arising as a result of engaging in the Event for whatever period said activity may continue. 

I recognize that scuba diving is a potentially dangerous activity, and I assume all risk of property damage, personal injury, or wrongful death for any cause including the negligence of individuals or others named herein. I understand that diving with compressed air or other mixed gasses involves certain risks and that injuries can occur which may require treatment in a recompression chamber. I further understand that the site of this activity is remote, either by time (~45 minutes) or distance (~15 miles) or both, from such a recompression chamber. 

I, my spouse (if any), assignees, heirs, guardians, and legal representatives hereby voluntarily indemnify, release from liability, agree to defend and hold harmless the City of Avalon, Catalina Divers Supply, and the Avalon Rotary Club Foundation, including its officers, trustees, employees, agents, representatives, student groups, students and any school, department, organization, group or individual affiliated therewith (collectively, the “Releasees”), for any accident, injury, illness, death, loss, theft, damage to person or property, or other consequences suffered by me arising or resulting directly or indirectly from my participation in the Event, including but not limited to claims arising from or related to the Releasees’ negligence. In the event that I am injured, I agree to assume any financial obligation, either through my health insurance, or through some other means, for any medical costs that I incur. The Releasees assume no responsibility for any medical expenses, injury, or damage suffered by me in connection with my participation in the Event. 

IT IS MY INTENTION BY SIGNING THIS AGREEMENT TO EXPRESSLY ASSUME ALL RISK OF SUCH PERSONAL INJURY, DEATH, OR PROPERTY DAMAGE UPON MYSELF, TO THE EXCLUSION OF THE RELEASEES, AND TO EXEMPT AND RELIEVE THE RELEASEES FROM LIABILITY FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH, INCLUDING IF CAUSED BY THE RELEASEES’ NEGLIGENCE. 

By signing this agreement, I waive my right to bring any legal action now or at any time in the future to recover compensation or obtain any other remedy for any injury to myself or my property or for my death, however caused, arising out of my participation in the Event. I further agree that I, my spouse (if any), assignees, heirs, guardians, and legal representatives will not make any claim against, sue or attach the property of the Releasees for any loss or damage resulting from my participation in the Event. I am aware of the potential danger’s incidental to participation in the Event, that this is a release of liability, a waiver of my legal right to collect damages in the event of injury, death or property damage, and a contract between me and the Releasees, and I sign it of my own free will. 

I expressly agree that this release is intended to be as broad and inclusive as the State of California will allow and that if any portion is held invalid, I agree that the balance shall, notwithstanding, continue in full legal force and effect. 

I acknowledge that I have read the foregoing, and the Safe Driving Practices, and am fully aware of the legal consequences of signing this instrument.

As a parent or guardian, I am signing this document on behalf of a minor child. Additionally, I have read and considered the above information and understand the risks of injury or death while scuba diving. I am aware of the legal consequences of signing this agreement, and do hereby agree to be specifically bound to all the specified terms and conditions on behalf of the minor child and myself. 

May 2, 2024



First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email
Check to receive information, news, and discounts by e-mail.
A signed copy of this waiver will be sent to the email address you provide.
Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!