Insurance Release Form
The form below, word for word must be signed and dated
before any camper may participate in any activities. This is a requirement for
insurance. Print a copy of this form (either right click, then select "print" or select FILE, then "print")
Sign and date the printed form, attach the registration fee and/or the balance due and the registration form (The registration form may be electronically
submitted from the REGISTER NOW! page.).
NOTE: You may also print, then FAX or Mail the Release Form as a PDF file
To Print the Release Form as a PDF file
PDF files are neater and easier to work with, but you need the FREE Acrobat Reader
Program to take advantage.
Acrobat is available FREE here ....
You may also FAX documents to us at: 757 721 9668
The RELEASE FORM begins below this line.
Discover Virginia
PARTICIPANT AGREEMENT, RELEASE, AND ACKNOWLEDGEMENT OF RISK
In consideration of the services of Discover Virginia, Inc.,
their agents, owners, officers, volunteers, participants, employees, and all other
persons or entities acting in any capacity on their behalf (hereinafter collectively
referred to as "D.V."). I hereby agree to release, indemnify, and discharge D.V., on
behalf of myself, my children, my parents, my heirs, assigns, personal representative
and estate as follows:
1. I acknowledge that my participation in outdoor adventure based activities such
as sea kayaking, swimming, canoeing, fishing, crabbing, seine netting, hiking, and
traveling to and from these activities entails known and unanticipated risks which
could result in physical or emotional injury, paralysis, death, or damage to myself,
to property, or to third parties. I understand that such risks simply cannot be
eliminated without jeopardizing the essential qualities of the activity. Furthermore,
D.V. guides/instructors/facilitators have difficult jobs to perform. They seek safety,
but they are not infallible. They might be unaware of a participant's fitness or
abilities, They might misjudge the weather, the elements, or the terrain. They may
give inadequate warnings or instructions, and the equipment being used might
malfunction
2. I expressly agree and promise to accept and assume all of the risks existing in this activity. My participation in this activity is purely voluntary, and I elect to participate in spite of the risks.
3. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless D.V. from any and all claims, demands, or causes of action, which are in any way connected with my participation in this activity or my use of D.V.'s equipment of facilities, including any such claims which allege negligent acts or omissions of D.V..
4. Should D.V. or anyone acting on their behalf, be required to incur attorney's fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs.
5. I certify that I have adequate insurance to cover any injury or damage I may cause or suffer while participating, or else I agree to bear the costs of such injury or damage myself. I further certify that I have no medical or physical conditions which could interfere with my safety in this activity, or else I am willing to assume - and bear the costs of - all risks that may be created, directly or indirectly, by any such condition.
6. In the event that I file a lawsuit against D.V., I agree to do so solely in the state of Virginia, and I further agree that the substantive law of that state shall apply in that action without regard to the conflict of law rules of that state. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect.
By signing this document, I acknowledge that if anyone is hurt or property is damaged during my participation in this activity, I may be found by a court of law to have waived my right to maintain a lawsuit against D.V. on the basis of any claim from which I have released them herein.
I have had sufficient opportunity to read this entire document. I have read and understood it, and I agree to be bound by its terms.
Signature of Participant:____________________________________________Printed Name:______________________________
(Must be completed for participants under the age of 18)
In consideration of ___________________________________(print minor's name) ("Minor")
being permitted by D.V. to participate in its activities and to use its equipment and facilities, I further agree to indemnify and hold harmless D.V. from any and all Claims which are brought by, or on behalf of Minor, and which are in any way connected with such use or participation by Minor.
Signature of Parent/Guardian:_____________________________________________
Date Signed:_____|______|_____ Printed Name:_________________________________________________________
The RELEASE FORM ends above this line.
Thanks!
If you have further questions or need additional information,
please contact us either by Email
or phone: 757 721 9668,
or FAX: 757 721 9668,
or SNAIL MAIL at:
DISCOVER VIRGINIA
c/o R. Venner
589 Princess Anne Road
Va. Beach, VA 23457
