Lake of the Pines Association

Hold Harmless Release and Waiver Assumption of Risk:

Lake of the Pines Association Recreation Department is sponsoring the following activity/activities:

Lake of the Pines Association Sailing School 2016

Please Fill out one form for each participant. Please indicate below if participant is a Member or Guest of Member. Per our Guest Policy, members must be in attendance with their Guest when using the amenities.

LOP Lot Number (required) : ______

Please check one:

LOP Member

Guest of LOP Member

My (my child’s) participation in this activity is voluntary. I am (my child is) physically fit to participate in this activity. I understand that this activity involves risks and that serious injuries could occur while I am (my child is) participating in this activity. In addition, if transportation is provided to the activity, serious injuries could occur. Knowing these risks, I want (my child) to participate in this activity.

I (on behalf of my child) hereby assume the risk, and hereby waive, release and discharge Lake of the Pines Association and, its’ council, officials, employees, agents, sponsors and promoters of this activity, for any and all claims for damages for personal injuries, or claims for any damages to property, which I (my child) or my (my child’s) heirs, assigns, executors or administrators may have or which may accrue to me (my child), arising out of my (my child’s) participation in this activity, including transportation to or from this activity.

I have read the above and understand that important legal rights are being waived.

I also consent to the Association’s use in its brochures and department fliers or any photographs that are taken of me (my child) while participating in the activity.

Name of participant(please print): ______Lot #: ______

Signature (required) ______Date: ______

Parent's Signature (If under 18): ______Date: ______

Email: ______

Medical Release:

In the event that I am not immediately available, should the participant suffer a serious or life-threatening injury for which emergency medical treatment may be necessary, I hereby authorize an appropriate employee or representative to engage qualified medical personnel to initiate any necessary treatment or care. In the event of such an injury, it is understood that Lake of the Pines Associationrepresentative will use all reasonable efforts to notify me or the emergency contact listed where practical, prior to initiating medical treatment for any such injury to the participant. (continued on back, turn over...)

Medical Release (continued):

Should neither party be available, an employee or representative will contact appropriate medical personnel to initiate the necessary medical treatment. I hereby give permission to any such physician or other medical personnel to provide such medical treatment which such individual deems medically appropriate.

I understand and agree that I am responsible for all medical care expenses incurred to treat participant’s injuries.

Name of Participant: ______

Name of Parent/Guardian(If under 18):

______

Participant’s (or Parent’s, if under 18) Signature (Required):

______Date: ______

Name of Regular Physician (please print):

______Phone: ______

Health Insurance Company: ______

I.D. #: ______

Emergency Contact: (List two)

Name: ______Phone: ______

Relation: ______

Name: ______Phone: ______

Relation: ______