Freedom Fishing Foundation Summer 2021 Trip #3 6/27-28 - Quad Area Chamber of Commerce
All applicants for a Fishing Trip through the Foundation must apply and meet the criteria for elgibility and provide supporting documents and a signed liability consent form.
- Required Field
First Name *
Last Name *
Date: April 19, 2021
Full Name of Qualified Applicant: *
Zip Code *
Email: (if none: enter N/A or a friend or family member) *
Emergency Contact Name *
Emergency Contact Phone # *
I am *
Select all that apply
Active or Reserve Military
Retired or Discharged Veteran
Purple Heart Reciipient
Disabled Veteran (% Service Connected)
Child of a Veteran (Minor Children must be accompanied with a Parent/Guardian).
Guest or Family Members
I request preferential priority related to:
Select all that apply
Combate Wounded or Purple Heart Recipient
PTSD or Traumatic Brain Injury
Family of Member Killed in Action or by Suicide
Provide Proof of Elgibility: Upload DD214, Active, Reserve, Retired ID card, Letter of Service Connected Disability, VA Health Care ID Card, DIC Identification Card *
If unable to provide elgibility, we are open to asking your County Veterans Service Officer to verify. You must be registered with the county you identify below. County:
RELEASE OF LIABILITY, WAIVER OF CLAIMS, INDEMNIFICATION,
AND ARBITRATION AGREEMENT
Notice –By signing this document you may be waiving certain legal rights, including the right to sue.
Release and Waiver of Claims; Indemnification Agreement
In consideration of being allowed to participate in fishing programs(“Programs”) with Freedom Fishing Foundation, the Participant, and the Participant’s parent(s) or legal guardian(s) if the Participant is a minor, do hereby agree, to the fullest extent permitted by law, as follows:
TO WAIVE ALL CLAIMS
that they have or may have against the Facility arising out of the Participant’s participation in the Programs and/or the use of any equipment provided by the Facility (“Equipment”). The Participant and his/her Parents or legal guardian(s) specifically understand that they are releasing any and all claims that arise or may arise from any negligent acts or conduct of the Facility, its owners, affiliates, operators, employees, agents, and/or officers.
Furthermore, I understand that Freedom Fishing Foundation reserves the right to use any pictures or videos taken during any programs for advertising and promotional purposes.
TO ASSUME ALL RISKS
of participating in the Programs and using the Equipment, even those caused by the negligent acts or conduct of the Facility, its owners, affiliates, operators, employees, agents, and/or officers. The Participant and his/her Parents or legal guardian(s)understand that the risks of participating in the Programs and using the Equipment may be both foreseen and unforeseen and include serious physical injury and/or death;
the Facility, its owners, affiliates, operators, employees, agents, and/or officers from all liability for any loss, damage, injury, death, or expense that the Participant (or his/her next of kin) may suffer, arising out of his/her participation in the Programs and/or use of the Equipment;
TO CONSENT AND AUTHORIZE
the Facility, its owners, affiliates, operators, employees, agents, and/or officers to obtain emergency medical treatment for me if I am injured du ring my participation in the event. I agree that I will be responsible for any medical costs incurred with respect to such emergency medical treatment; and
the Facility, its owners, affiliates, operators, employees, agents, and/or officers, from all liability for any loss, damage, injury, death, or expense that the Participant (or his/her next of kin) may suffer, arising out of participation in Programs and/or use of the Equipment.
The Participant understands that he/she is obligated to follow the rules of the Programs and that he/she can minimize his/her risk of injury through the exercise of common sense and by being aware of his/her surroundings. If, while participating in the Programs, the Participant observes any unusual hazard, which he/she believes jeopardizes his/her personal safety or that of others, he/she will remove himself/herself from participation in the Programs and immediately bring said hazard to the attention of the Facility.
I HAVE READ AND UNDERSTAND THIS AGREEMENT AND I AM AWARE THAT BY SIGNING THIS AGREEMENT I MAY BE WAIVING CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE. Parents or Guardians must also sign if the Participant is UNDER 18. Â
Parent or Guardian Signature
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