Waiver, Team Waiver, Acknowledgement of Risk, Agreement to obey Rules & Regulations, "Voluntary" Medical Form

 

Link to printable Waivers and voluntary medical form. LivelyDragonWaivers2011.doc

 

 

For those participants that have registered online, have read and agreed to the online waiver, acknowledgement of risk, and team waiver do not need to bring a copy of this form to the registration.

 

Any persons that have not completed the online registration will need to present these forms to the registration desk before being allowed to participate.

 

Dear Team Captains, Managers and Members

 

The Attached waiver forms have been changed to facilitate the signing process and reduce the amount of paper that needs to be handled.

The waiver consists of :

Please have team members sign the combined Team waiver signature page on the same line as on the Team waiver. This will help speed up process your team on race day.

Please insure that persons using Appendix B1 have copies of Appendix “A, B, and C” to review with their parents or guardians and that their position on the team waiver is indicated on the returned form.

Please ensure that there are sufficient copies of  “Appendix C: Participant Medical Information Form” readily available to all team members

Please assemble the forms in order of “Team waiver” then “Combined Team waiver signature page” then individual Appendix B1” then “Appendix A & B” Then any submitted “Appendix C Medical Information Form” attached on the bottom.

Please submit all completed forms on race day to the registration desk.

Have a great race day!!

Also included for your convenience is a Planning sheet for team Captains or Managers, “Not to be handed in”

  __________________________________________

ALL team members: must read Appendix A, Appendix B and Appendix C, then sign this signature page. In the same line as they have signed on the Team waiver.

Appendix A: Team: Participants Application and Assumption of Risk and Responsibility Agreement

Appendix B: Participants promise to obey and adhere to the rules and regulations of Lively Dragon. Personal insurance waiver and release of liability form  “Please Read Carefully”

Appendix C: Participant Medical Information Form, “ this is at the paddlers discretion” Indicate Yes if you have included one or No if not.

Team Captain Cell phone ___________________ phone at race site if different ______________________

Medical Form ?

	Sign Name	Print Name	Email	Yes/No
Captain
2
3
4
5
6
7
8
9
10
11
12
13
14
15
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17
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25

 

       ______________________________________

 

Appendix A

Participants Application and Assumption of Risk and Responsibility Agreement Participants promise to obey and adhere to the rules and regulations of Lively Dragon.

•Ø Think safety at all times.

•§     Lifejackets must be worn and properly fastened at all times.

•§     Buddy System, understand how this works and the value there in.

•§     Remember you are ultimately responsible for your safety.

•§     Know what to do in the event of a mishap and the procedure to follow.

•§     All orders given pertaining to safety must be complied with immediately.

•§     We each are responsible for the safety of one another.

•§     Insure you are aware of the required safety equipment and the use of it.

•§     Insure that you and fellow participants are free of any ropes in the boat.

•§     Know where the first aid kit is kept.

•§     Know location of the nearest phone. (mobile phone mandatory on boat)

•§     Appropriate non-slip footwear should be worn.

•Ø In the event of a capsize…REMAIN CALM

•§     Find your buddy and signal ‘thumbs up’

•§     If you cannot find your buddy, make everyone aware a person is not accounted for.

•§     Follow instructions of the person in charge.

•§     Insure you are not between the capsized vessel and approaching vessel.

•§     Hypothermia is a real possibility at any time when on or in the water.  Particularly during the spring, fall and winter.  Understand and recognize the condition in yourself and fellow participants. Dress and act appropriately to minimize this risk.

•§     Any water environment has inherent risks.  This is particularly true when dragon boating on any river or body of water that may have a current.

•Ø We are here to learn, participate, contribute and look out for one another.

•§     If you have a question or a concern ‘ask’

•Ø Both waiver forms must be completed, signed and given to the person in charge prior to any participation.

•§     Swimming competency must be indicated for everyone’s safety.

•§     Swimming ability is preferable though not a prerequisite to participation.

I understand if the team coach, captain or manager feels that any participant is behaving in a manner detrimental to the safety or enjoyment of himself or the team they will be asked to either conform or they will not be allowed to participate any further. I have read and understand the above statements, and with this knowledge I still volunteer to take part in this event and accept such risks as being part of the nature of this sport.

   __________________________________________

 

Appendix B

Personal insurance waiver and release of liability form  “Please Read Carefully”
Covenant Not to Sue/Release of Liability, Waiver of Claims, Assumption of Risks and Indemnity Agreement “By signing this document you waive certain legal rights, including the right to sue”
I, hereby release Lively Dragon Club, Hamilton Region Conservation Authority, City of Hamilton, Toronto And Region Conservation Authority, City of Toronto, Conservation Halton, City of Burlington, Grand River Conservation Authority, The Grand River, Canadian Heritage River Systems, Corporate Event Hosts, School Boards, Race Teams, Parks and Recreation and their respective directors, member, trustees, agents, representatives, officers, sponsors, licensors, servants, volunteers, employees, team members, (“The Releasees”) from all claims for damages arising from participation of the applicant heron during any program or in any location where a program is held, and agree to and save them HARMLESS AND INDEMNIFY them from and against any and all liabilities, claims, injuries, losses, damages, expenses, demands, actions, and causes of action of whatsoever kind or nature arising out of or related to any such loss, damage, or injury, including death, etc. that may be sustained by me for what so ever reason while participating in the dragon-boats.net, races, practice sessions, meetings, gatherings, demonstrations or upon the premises, grounds or waterways supervised or controlled by Dragon-Boats.net, Lively Dragon Race, Hamilton Region Conservation Authority, City of Hamilton, Race Teams, Parks and Recreation and their respective directors, member, trustees, agents, representatives, officers, sponsors, licensors, servants, volunteers, employees, team members Whether such damages are the result of negligence or for any other reason or cause. 
I, also agree to and discharge forthwith on request The above Releasees of each and every obligation or claim which shall be made, assigned or appointed against the Releasees by any party by virtue of any injury or damage caused by me or to me absolutely. 
I, and my next-of-kin are duly aware of the risks and hazards inherent in the sport of paddling and entering the premises used for the purpose of launching, docking and storing equipment used in the sport of paddling, and specifically in participating in Lively Dragon Club and the practice sessions held at said premises and participating is said event, knowing conditions may be hazardous and dangerous and that obstruction may exist, and that high winds may cause rough water, I hereby give notice that I am a competent swimmer and that I voluntarily assume all risk of loss, damage or injury, including death, that may be sustained by me or to any property while in or upon said premises or engaged in said event.
I, Agree to properly wear, at all times while participating in the Lively Dragon Club event, including any practice sessions arranged through the Lively Dragon Club, a Personal Floatation Devices "PFD" often referred to as a Lifejacket of an appropriate size, in good condition approved by Canadian Coast Guard.  I give permission to Lively Dragon to take photographs and/or videos of me participating in any related activities and authorize the use of any such images for purpose of publicity, advertising, and training.
In signing the foregoing release, I / we hereby acknowledge and represent, that I/ we have read the forgoing waiver, , Appendix “A” and “C”, have not changed the waiver orally. I / we of sound mind understand the waiver and agree to the waiver voluntarily, that I am 18 years of age or older and the best of my knowledge am fit to participate, or have co-signed with a parent or guardian, as the case maybe.

  ___________________________________________

 

Appendix B  (co-signed with a parent or guardian for paddlers under 18 years of age)

Personal insurance waiver and release of liability form  “Please Read Carefully”
Covenant Not to Sue/Release of Liability, Waiver of Claims, Assumption of Risks and Indemnity Agreement “By signing this document you waive certain legal rights, including the right to sue”
I, hereby release Lively Dragon Club, Hamilton Region Conservation Authority, City of Hamilton, Toronto And Region Conservation Authority, City of Toronto, Conservation Halton, City of Burlington, Grand River Conservation Authority, The Grand River, Canadian Heritage River Systems, Corporate Event Hosts, School Boards, Race Teams, Parks and Recreation and their respective directors, member, trustees, agents, representatives, officers, sponsors, licensors, servants, volunteers, employees, team members, (“The Releasees”) from all claims for damages arising from participation of the applicant heron during any program or in any location where a program is held, and agree to and save them HARMLESS AND INDEMNIFY them from and against any and all liabilities, claims, injuries, losses, damages, expenses, demands, actions, and causes of action of whatsoever kind or nature arising out of or related to any such loss, damage, or injury, including death, etc. that may be sustained by me for what so ever reason while participating in the dragon-boats.net, races, practice sessions, meetings, gatherings, demonstrations or upon the premises, grounds or waterways supervised or controlled by Dragon-Boats.net, Lively Dragon Race, Hamilton Region Conservation Authority, City of Hamilton, Race Teams, Parks and Recreation and their respective directors, member, trustees, agents, representatives, officers, sponsors, licensors, servants, volunteers, employees, team members Whether such damages are the result of negligence or for any other reason or cause. 
I, also agree to and discharge forthwith on request The above Releasees of each and every obligation or claim which shall be made, assigned or appointed against the releasees by any party by virtue of any injury or damage caused by me or to me absolutely. 
I, and my next-of-kin are duly aware of the risks and hazards inherent in the sport of paddling and entering the premises used for the purpose of launching, docking and storing equipment used in the sport of paddling, and specifically in participating in Lively Dragon Club and the practice sessions held at said premises and participating is said event, knowing conditions may be hazardous and dangerous and that obstruction may exist, and that high winds may cause rough water, I hereby give notice that I am a competent swimmer and that I voluntarily assume all risk of loss, damage or injury, including death, that may be sustained by me or to any property while in or upon said premises or engaged in said event.
I, Agree to properly wear, at all times while participating in the Lively Dragon Club event, including any practice sessions arranged through the Lively Dragon Club, a Personal Floatation Devices "PFD" often referred to as a Lifejacket of an appropriate size, in good condition approved by Canadian Coast Guard.  I give permission to Lively Dragon to take photographs and/or videos of me participating in any related activities and authorize the use of any such images for purpose of publicity, advertising, and training.
In signing the foregoing release, I / we hereby acknowledge and represent, that I/ we have read the forgoing waiver, Appendix “A” and “C”, have not changed the waiver orally. I / we of sound mind understand the waiver and agree to the waiver voluntarily, that I am 18 years of age or older and the best of my knowledge am fit to participate, or have co-signed with a parent or guardian, as the case maybe.

Team name:		Number on Team Waiver:
Team Captain:
Print your name:		Sign your name:
Your e-mail:		Date signed:
Witness name:		Witness sign:
Date signed:
Parent/Guardian name:		Parent/Guardian sign:
Phone Number:
Date signed:		Appendix “C” Yes/no:

 

  _________________________________________

 

 

Appendix C  
(Team captain please insure this form is readily available to team members)

Participant Medical Information Form  this is at the paddlers discretion

Name: ________________________________________ Sex (    ) M   (    ) F

Date of Birth: Day ______Month _______________Year ____________

Person to be contacted in case of emergency _______________________________________________

Phone numbers: Day __________________       Evening_______________________

Family Doctor: __________________________ Phone number: ______________________

Relevant Medical History:

Important Medical Considerations: _______________________________________________________

Medications: _________________________________________________________________________

Blood Type: _________________________________________________________________________

Allergies: ____________________________________________________________________________

Previous injuries illnesses or operations: ____________________________________________________________________________

Can the participant/athlete administer his/her own medication(s) Yes (_______) No (________)

Medication instructions: _________________________________________________________________
     (Please note we are not authorized to give medication but can assist you with your medication)

Other concerns: (Prosthesis, contact lenses, etc.) notes:

______________________________________________________________________________

______________________________________________________________________________

I assume full responsibility for my health being such that the activities will in no way aggravate any conditions present or present a risk to my fellow paddlers.  If in doubt, I will seek and follow medical advice.

Signature: ___________________________________ Date: ___________________________

Note: the participant / athlete Participant Medical Information Form is a confidential document.

 

 ____________________________________________

 

Team Wavier Form: captain responsible for returning this form. ALL team members must sign this form. 

Team members under the age of 18 require a written consent and a wavier signed by a parent or legal guardian. 

I/ we have read and signed waiver, Appendix “A”, “B” , read and had the opportunity to submit Appendix “C”
In consideration of my being permitted to participate in any Lively Dragon Activities, I myself, my heirs, executors, administrators, successors and assignees Hereby Release, waive and forever discharge Lively Dragon Club, Hamilton Region Conservation Authority, City of Hamilton, Toronto And Region Conservation Authority, City of Toronto, Conservation Halton, City of Burlington, The Corporation of the City of Cambridge, Riverbluffs Park, Grand River Conservation Authority, The Grand River, Canadian Heritage River Systems, Corporate Event Hosts, School Boards, Race Teams, Parks and Recreation, any and all others directly involved in the Activities and their respective directors, member, trustees, agents, representatives, officers, sponsors, licensors, servants, volunteers, employees, team members, (“The Releasees”) of and from all claims, demands, costs, expenses, actions and causes of action, whether in law or equity, in respect of death, injury, loss or damage to my person or property result of negligence or for any other reason or cause or to by reason of my participation in the said event, whether as a spectator, participant, competitor or otherwise prior to, during or subsequent to the event and do notwithstanding  that same may have been contributed to or occasioned by negligence of any of the aforesaid.. I further hereby undertake to hold and save harmless and agree to indemnify all of the aforesaid from and against any and all liability incurred by any way connected with my participation in the said event.  I have read and understand the Canadian Government “

SAFE BOATING GUIDE”. Link access http://www.ccg-gcc.gc.ca

I give permission for the free use of my name and picture in broadcast, television or written account of this event.

I have read or had read to me, understood and agree to the above waiver, release and indemnity.  

 Team Name: __________________________________ Date: _________________________

w/n		Sign Name	Print Name	Email
Captain
	2
	3
	4
	5
	6
	7
	8
	9
	10
	11
	12
	13
	14
	15
	16
	17
	18
	19
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	23
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	25

  Team members under the age of 18 require a written consent and a wavier signed by a parent or a legal guardian.