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American Slalom Excellence Program Waiver
The undersigned applicant (and, if the applicant is a minor, the undersigned parent or legal guardian of the applicant) hereby releases and discharges and further agrees to indemnify and hold harmless, the Coaches, Davey Hearn, Jennifer Hearn, Ben Kvanli of the American Slalom Excellence Program, its volunteers, directors, officers, employees and agents, and each of their successors and assigns from any and all claims for damage or loss to the applicant, the American Slalom Excellence Program or any other person or entity which may arise out of or result from the applicant’s participation in any American Slalom Excellence Program or activity. This waiver, release and indemnity is given with full understanding that such programs and activities, including, but not limited to, whitewater paddling and the maintenance of whitewater paddling facilities, are dangerous and involve risk of sudden injury, including risk of permanent disability and death, and may involve risks not known or reasonably foreseeable at this time.
Note: Minors are less than 18 years of age at time of application a Parent or legal guardian must sign under Signature of Applicant.
_______________________________ _______________ __________________ Signature of Applicant Date Relationship to Minor
_______________________________ __________________________________ Printed Name of Applicant USA Canoe Kayak Membership # Required
Please return signed form to: David Hearn, 6211 Ridge Drive, Bethesda, MD 20816-2641 USA
updated 08/11/05
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