release form - University of North Carolina Wilmington

Nickname/Name Gone By
UNCW ADVENTURE RECREATION PROGRAMS
______________________
ACKNOWLEDGMENT AND ASSUMPTION OF RISK
POOL CLINICS, WHITEWATER/OCEAN ACTIVITIES, KAYAK TOURING ACTIVITIES
I understand and accept that whitewater/ocean paddling in a canoe, kayak or inflatable craft
exposes me to numerous known and unanticipated risks which could result in personal injury,
illness, death or damage to myself or my property. Some of the risks or factors creating risk
include, but are not limited to the following:
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The hazards of travel in an inflatable craft, a canoe or kayak in rough water conditions
Water hazards including boulders, trees and other obstacles, waterfalls, holes, reversals
and other water formations
Swimming/floating in unfamiliar and sometimes turbulent water
Using paddles, ropes, and other paddling equipment
Hiking or walking in rugged terrain including slippery rocks
Injuries inflicted by animals, insects, reptiles or plants
Accidents or illness in remote places without medical facilities
Man-made objects in the river/ocean including but not limited to; ropes, bridge pilings, and
metal junk
Carrying, loading or unloading of inflatable craft, canoes, kayaks and other river/ocean
equipment
The forces of nature including lightning, weather changes, river/ocean level changes and
others not named
My physical condition, the physical exertion associated with paddling and swimming in
whitewater/ocean
Travel in a vehicle not driven by me
I agree to accept and assume all responsibility for and risk of personal injury, illness death or
damage to myself, or my property arising from my participation in this whitewater / ocean
activity. My participation is voluntary. I choose to participate in this whitewater/ocean activity
in spite of these named and unnamed risks. I am solely responsible for deciding to participate
in this activity, and am solely responsible for deciding what equipment to take, whether to
scout or run any rapid and whether to participate in any rescue or recovery of equipment. I am
solely responsible for deciding whether to participate in or continue on any river / ocean trip.
I understand my responsibility in decision-making. I agree to obey all Adventure Recreation
Programs rules and regulations while participating in this whitewater/ocean activity.
I have carefully read and understand this Acknowledgment and Assumption of Risk, I also
understand that I will be asked to read carefully, understand and sign a separate Release of
Liability.
Participant's Signature
Printed Name
Date
Parent or Guardian's Signature
(if under 18 years of age)
Printed Name
Date
Emergency Contact Name: ___________________________ Relation to Participant: ____________
Home Phone: (____) _____-________ Cell: (_____) _____-________ Work: (_____) _____-________
UNCW ADVENTURE RECREATION PROGRAMS
RELEASE OF LIABILITY
I hereby acknowledge that I have read the Acknowledgment of Risk and have agreed to its
terms. I fully understand that there are certain elements of danger inherent in recreational
activities, and that participating in a recreational activity could entail loss of life, personal
injury, and loss of or damage to property.
I understand and agree that the terms "recreational activity" and "activity" as used herein
encompass all aspects of the activity, including preliminary and subsequent matters such as,
but not limited to getting outfitted for the activity, maintaining, repairing, loading and
unloading boats, equipment or gear, and travel to and from the place of activity.
In consideration of Adventure Recreation Programs, furnishing services to enable me to
participate in this activity, I hereby voluntarily release and forever discharge the University of
North Carolina at Wilmington (UNCW) Adventure Recreation Programs and its officers, agents
and employees from any and all liability or claims for any injury, illness, death, or damage to
myself or my property arising out of or in any way connected with my participation in this
activity. This release and discharge specifically includes, but is not limited to, liability or claims
based upon the ordinary negligent acts or omissions of Adventure Recreation Programs or its
officers, agents or employees.
I further agree, promise and covenant not to sue, assert or otherwise maintain any claim
against Adventure Recreation Programs or its officers, agents or employees, for any injury,
illness, death or damage to myself or my property arising from or in any way connected with
my participation in this activity.
In signing this document, I fully recognize that if injury, illness, death or damage occurs to me
while I am engaged in this activity, I will have no right to make a claim or file a lawsuit against
UNCW, Adventure Recreation Programs, Campus Recreation or its officers, agents or
employees, even if they or any of them negligently cause my injury, illness, death or damage,
unless that negligence is gross or willful negligence.
I hereby grant UNCW Adventure Recreation Programs the right to use, for promotional
purposes only, any photographs taken by them of me during my participation in their
recreational activities.
I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM
AWARE THAT THIS IS A RELEASE OF LIABILITY AND I SIGN IT OF MY OWN FREE WILL.
Participant's Signature
Printed Name
Date
Parent or Guardian's Signature
(if under 18 years of age)
Printed Name
Date