DRIFTWOOD KAYAK:
CONFIDENTIAL MEDICAL QUESTIONNAIRE & LIABILITY RELEASE FORM

Kayaking is an activity that requires a certain level of physical ability to make it an enjoyable experience. To assure that you to get the most from your experience with Driftwood Kayak, please answer these few questions as accurately as possible. Please be assured that this information is for our use only and will not be shared with anyone else.

Name *
Name
Date *
Date
Phone *
Phone
Address *
Address
Do you have serious allergies to plants, food, insects or other things that might be triggered during our activity? If so, please list here: If you do have such allergies, do you carry medication for emergency treatment? If so, please state where the medication is and how it should be administered.
Do you have any other types of medical conditions such as heart issues or asthma, which might require emergency medication? If so, please state where the medication is and how it should be administered.
Do you have any joint or muscular issues that may impact your ability to participate? If so, please briefly describe.
Is there anything else about your medical condition which may impact your participation in this activity? If so, please describe.

Liability Release Agreement:

In consideration of the services and property provided by DRIFTWOOD KAYAK (hereafter “DK”), its agents, owners and employees the undersigned acknowledges and agrees as follows:

1. WARNING. I acknowledge that there are significant elements of risk in any activity associated with the use of watercraft, including, but not limited to kayaking, which risks cannot be eliminated without jeopardizing the essential qualities of the activity. These risks are inherent in the activity and may be present even when equipment is used properly and proper instruction is given.

2. Scope of Release. This release of liability covers all activities indirectly or directly associated with the use of DK equipment, facilities, services and activities relating to kayaking, and including any and all instructional guiding services provided by or organized by DK.

3. Assumption of Risk. By executing this Release of Liability the undersigned expressly and voluntarily assumes all risk that arises from the use of DK equipment and participation in DK activities, the acts of others, the unavailability of emergency care or rescue services, and any other foreseeable or unforeseeable factors or circumstances related to the rental and use of the equipment and participation in the activities of DK. The undersigned assumes all risk of injury, wrongful death or property damage related to the use of the equipment and participation in the activities of DK, and loss of any personal property.

4. Physical Condition and Skills. The undersigned represents that he or she has the requisite, physical ability and mental ability necessary for proper and safe use of the equipment and will comply with instruction, directives and requests made by representatives of DK, relating to the use of the equipment and participation in the activity. The undersigned agrees to wear a life jacket at all times when in the water.

5. Release. The undersigned hereby releases, discharges, waives, disclaims and relinquishes all claims, action or causes of action against DK, its owners, employees and agents (each an “indemnitee”) and hold them harmless from any or all claims, causes of action, damage judgments, costs or expenses, including attorney fees which in any way arise from the rental and use of equipment and participation in activities of DK, which include but are not limited to damages to or destruction of any property of an indemnitee or of any others, injury or death of the undersigned or anyone else, or any liability arising from the act or negligent act of an indemnitee, the undersigned or anyone else; provided, however, the foregoing indemnity shall not apply to claims relating to solely to the gross negligence or willful misconduct of DK, its agents, owners and employees.

6. Acknowledgment. The undersigned has read and understands this Release of Liability and realizes it relates to surrendering legal rights and assuming important legal responsibilities and does so freely and voluntarily.

The undersigned has executed this Release of Liability for himself or herself, his or her heirs, assigns and legal representatives. In the event of minor is involved in the use of equipment of DK or participation in an activity organized or supervised by DK, the parent or legal guardian of the minor signs on behalf of said minor, agreeing to the terms hereof, with the same releases, and agrees to indemnify DK for the minor’s actions, in the event such indemnity would apply to an adult renter.