Kayak Chapel Liability Release Form

*All participants must be physically able to kayak solo and know how to swim.*

First Name

Last Name

Phone Number

In consideration of my participation at Kayak Chapel, I am fully aware of possible injury and life threatening situations that may occur while kayaking.

I agree

I do not agree

In consideration of my participation at Kayak Chapel, I am not aware of any personal physical or medical conditions that would hinder and/or restrict my ability to fully participate in this activity.

I agree

I do not agree

Following the pronouncements above I hereby declare the following: I am fully and personally responsible for my own safety and actions while and during my participation and I recognize that I may in any case be at risk of injury.

I agree

I do not agree

Following the pronouncements above I hereby declare the following: With full knowledge of the risks involved, I hereby release, waive, discharge the Florida Conference of the United Methodist Church, First United Methodist Church of Miami, Inc., and St. John’s on the Lake UMC, and their board, officers, independent contractors, affiliates, employees, representatives, successors, and assigns from any and all liabilities, claims, demands, actions, and causes of action whatsoever, directly or indirectly arising out of or related to any loss, damage, injury, or death, that may be sustained by me while participating in Kayak Chapel while in, on, or around the premises or while using the equipment provided that may lead to unintentional harm.

I agree

I do not agree

Following the pronouncements above I hereby declare the following: I agree to indemnify, defend, and hold harmless the Florida Conference of the United Methodist Church, First United Methodist Church of Miami, Inc., and St. John’s on the Lake UMC, and their representatives from and against any and all costs, expenses, damages, lawsuits, and/or liabilities or claims arising whether directly or indirectly from or related to any and all claims made by or against any of the released party due to injury, loss, or death from or related to Kayak Chapel.

I agree

I do not agree

Following the pronouncements above I hereby declare the following: I agree to inform First United Methodist Church of Miami, Inc. and St. John’s on the Lake UMC if I have been injured and I will take full responsibility of seeking medical care.

I agree

I do not agree

I have read the foregoing Liability Release Waiver and understand its contents; that I am at least eighteen (18) years old and fully competent to give my consent; That I have been sufficiently informed of the risks involved and give my voluntary consent in signing it as my own free act and deed; that I give my voluntary consent in signing this Liability Release Waiver as my own free act and deed with full intention to be bound by the same, and free from any inducement or representation.

I agree

I do not agree

Today's Date

Participant's Signature