Waiver

Waiver and Release: (Each participant will need to complete this form)
I fully understand that training for and participating in activities such as The Rotary Club of Youngtown’s Soggy Bottom Cardboard Box Boat Regatta races may result in accidents, illness or serious injury. I am voluntarily participating in the Soggy Bottom Cardboard Box Boat Regatta and races (hereinafter the “event”) sponsored by the Rotary Club of Youngtown (hereinafter “the Rotary Club”) with complete understanding of the risks and dangers associated with participation in the event.
I further acknowledge that this event requires participants to be in proper physical condition. By signing this Waiver and Release Form, I declare that I am medically able, properly trained, physically fit and capable of participating in the event.
I agree to indemnify and hold the Rotary Club, its affiliates, members, directors, officers, agents, and employees and any other group or individuals associated with the event and any of their servants, agents, officials or employees free and harmless from any liability, loss, cost or expense including legal fees, which may result from my participation in the activities. I agree that I am fully responsible for payment of all costs resulting from the rendering of medical aid and ambulance services to me as a participant in any race activities and I authorise that all necessary first aid steps may be taken as prescribed by qualified personnel.
I also grant full permission to use any photographs, videotapes, recordings or any other record of my participating in the race program for any purpose. By signing below, I agree that I understand and consent to this statement.

Name of participant: _______________________________________________
Team/Boat name: __________________________________________________
Date: _________________________
Address: __________________________________________________________
___________________________________________________________________
Phone number:___________________
Email: _____________________________________________________________
Date of birth: _____________________
Signature of participant/guardian: ___________________________________
(if under 18 Parent or Guardian signature and name)
Name: ____________________________
Contact in case of emergency: _______________________________________
Phone: ____________________________

Download WAIVER & RELEASE form, print, sign and bring to the event.
Each participant competing will need their own form.


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