Blackfly Scullers

Full Name:

Gender:

Male Female

Partner's Full Name if rowing a double:
(enter N/A if not applicable)

Gender:

Male Female

Age:

Partner's Age if rowing a double:
(enter N/A if not applicable)

Address 1:

Address 2:

City / State / Zip:

Phone Number:

Email:

Please enter me in the following Swarm:

BLACK FLY REGATTA T-SHIRT ORDER FORM

(T-shirts cost $20 apiece --orders received by June 16 will be at the venue, those received after June 16 will be mailed to you in July)

Size:

S M L XL

Quantity:

Total Due:

RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT

IN CONSIDERATION of being given the opportunity to participate in any Black Fly Scullers, Inc, ("Club") activities including but not limited to the Seventh Inaugural Black Fly Regatta ("Activity") until the end of this calendar year, I, for myself, my personal representatives, assigns, heirs, and next of kin: 
                ACKNOWLEDGE, agree, and represent that I understand the nature of Rowing Activities, both on water and land based, and that I am qualified, in good health, and in proper physical condition to participate in such Activity. 
                FULLY UNDERSTAND that: (a.) ROWING ACTIVITIES INVOLVE RISKS AND DANGERS of serious bodily injury, including permanent disability, paralysis, and death ("Risks"); (b.) these Risks and dangers may be caused by my own actions, or inactions, the actions or inactions of others participating in the Activity, the condition in which the Activity takes place, or the negligence of the Releases named below; (c.) there may be other risks and social and economic losses either not known to me or not readily foreseeable at this time; and I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES I incur as a result of my participation in the Activity. 
                AGREE AND WARRANT that I will examine and inspect each Activity in which I take part as a member of the Club and that, if I observe any condition which I consider to be unacceptably hazardous or dangerous, I will notify the proper authority in charge of the Activity and will refuse to take part in the Activity until the condition has been corrected to my satisfaction.
                HEREBY RELEASE, discharge, and covenant not to sue the Club, their administrators, directors, agents, officers, volunteers and employees, other participating regatta organizers, any sponsors, advertisers,, and, if applicable, owners and lessors of premises, on which the Activity takes place, (each considered one of the Releasees herein) from all liability, claims, demands, losses or damages on my account caused or alleged to be caused in whole or in part by the negligence of the Releasees or otherwise, including negligent rescue operations; and I further agree that if, despite this release and waiver of liability, assumption of risk, and indemnity agreement, I, or anyone on my behalf, makes a claim against any of the Releases, I WILL INDEMNIFY, SAVE AND HOLD HARMLESS each of the Releasees from any litigation expenses, attorney fees, loss, liability, damage, or cost which may incur as a result of such claim.

I have read the above Release and Waiver of Liability, Assumption of Risk and Indemnity Agreement in its entirety and fully understand its terms. I understand that I have given up substantial rights by typing my initials below, and that I initial freely and without any inducement or assurance of any nature. I intend my initals to indicate a complete and unconditional release of the Black Fly Scullers and its affiliates of all liability to the greatest extent allowed by law and agree that if any portion of the Release and Waiver of Liability.
Assumption of Risk and Indemnity Agreement is held to be invalid, the balance, notwithstanding, shall continue in full force. I also fully understand that if I participate outside of my Swarm I will be deemed by the Constitutional Monarch to have broken the Black Fly Regatta Golden Rule - no porta potty for me. The only thing I'll find poached at the Black Fly Regatta are Pete & Gerry's eggs. Taper Hard!

Initial here:

and

Members under the age of 18, please print the Release and Waiver of Liability, Assumption of Risk and Indemnity Agreement above, have your parents sign and date it, and bring it with you to the regatta. We cannot allow you to race if you do not have your Release properly signed and on your person the day of the regatta - no excuses.

Black Fly Scullers * 1382 Fellows Road * Danville, Vermont 05828
* Phone:(802)748-0883 * Fax:(802)748-4323