ADULTS ONLY WAIVER READ BEFORE SIGNING WESSELMAN NATURE SOCIETY ADULT WAIVER AND RELEASE OF LIABILITY Revised 4/18/2006

IN CONSIDERATION of being permitted to participate in any way in the Wesselman Nature Society Canoe Evansville program 3. HEREBY RELEASE, INDEMNIFY, HOLD HARMLESS, and related activities (“Activities”) I, for myself, my personal DISCHARGE, AND COVENANT NOT TO SUE Wesselman representatives, assigns, heirs, and next of kin: Nature Society (the “Society”), The City of Evansville, Evansville Levee Authority, the Evansville Parks Department, 1. ACKNOWLEDGE, agree, and represent that I (the and their respective organizers, sponsors, volunteers, supervisors, undersigned) understand the nature of canoeing, paddlesports, employees, officers, directors, administrators and agents, other water activities and related activities (collectively the participants, any sponsors, advertisers, owners and lessors of “Paddlesport Activities”) and that I am qualified, in good health, premises on which the Paddlesport Activities takes place, in proper physical condition to participate in such Paddlesport (collectively the “Releasees”) from any and all liability, claims, Activities and willingly agree to comply with the stated and demands, actions, causes of action, losses, injuries, damage to customary terms and conditions of participation. I further agree property, or other damages which may be sustained to the and warrant that if at any time I believe conditions to be unsafe, I undersigned or the undersigned’s minor child as a result of their will immediately discontinue further participation in the respective participation and affiliation with Paddlesport Paddlesport Activities. If I decide to leave early and not Activities and which may be caused or alleged to be caused in complete the trip as planned, I assume all risks inherent in my whole or in part by the fault, negligence, willful, wanton, and/or decision to leave. intentional conduct of the Releasees or otherwise, including but not limited to negligent rescue operations; and I FURTHER 2. FULLY understand and acknowledge that: (a) there are risks, AGREE that if, despite this RELEASE AND WAIVER OF hazards and dangers associated with participating in Paddlesport LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY Activities including, but not limited to, those caused by weather AGREEMENT I, or anyone on my behalf, makes a claim against conditions, equipment condition, facility condition, site any of the Releasees, I WILL INDEMNIFY, SAVE, AND conditions, physical fitness condition, and other participates, in HOLD HARMLESS EACH OF THE RELEASEES from any addition to the act of using, paddling, riding, swimming, lifting, litigation expense, attorney fees, loss, liability, damage, or cost pulling, carrying, stretching, or launching a canoe or other which any may incur as the result of such claim. equipment and collisions with other participates, canoes, vehicles, spectators, or stationary objects, any of which may I HAVE READ THIS AGREEMENT, FULLY UNDERSTAND cause, personal property damage, serious bodily injury, ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP including permanent disability, paralysis, and/or death to myself SUBSTANTIAL RIGHTS BY SIGNING IT AND HAVE or another participate (collectively the “Risks”); (b) these Risks SIGNED IT FREELY AND WITHOUT ANY INDUCEMENT may be caused in whole or in part by my own actions or OR ASSURANCE OF ANY NATURE AND INTEND IT TO inactions, the actions and/or inactions of others, the conditions BE A COMPLETE AND UNCONDITIONAL RELEASE OF under which the Paddlesport Activities takes place, or the fault, ALL LIABILITY TO THE GREATEST EXTENT ALLOWED negligence, willful, wanton, and/or intentional conduct of the BY LAW AND AGREE THAT IF ANY PORTION OF THIS Releasees (hereinafter defined); (c) there may be other risks and AGREEMENT IS HELD TO BE INVALID THE BALANCE, social and economic losses either known or not known to me or NOTWITHSTANDING, SHALL CONTINUE IN FULL not readily foreseeable at this time; and ALONG WITH THE FORCE AND EFFECT. By participating in a Society program, RISKS SET FORTH ABOVE, I FULLY ACCEPT AND all participants grant the Society permission to use and publish ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY their photographs. The Society is allowed all rights, title and FOR LOSSES, COSTS, AND DAMAGES I incur as a result of interest in the finished work and may transfer the same to digital my participation in the Paddlesport Activities. or print media.

Name (print) ______Date of Birth ______Address______City ______State ______Zip______Email ______Phone ______Date ______Adult Signature______Club/Organization ______Witness ______Date______

Please Send Wesselman Nature Society information to my: □ email address □ mailing address (check one if interested) Wesselman Nature Society Medical Treatment Release

To Whom It May Concern: In the event of injury or illness, I authorize the staff and/or volunteers of Wesselman Nature Society and/or it’s representatives (on behalf of myself and/or child ward) to obtain first aid and/or medical treatment at the nearest and most adequate facility of Wesselman Nature Society’s choice.

Wesselman Nature Society program title: Canoe Evansville

Name of Participant: ______

Dates when the release is effective:______

Emergency Contact Name:______

Address:______

City, State, Zip: ______

Relationship:______Phone#:______

Medical History Do you have any allergies, including reactions to insect bites/stings, medications, or food? ______Are you currently taking any medication? ______Medication ______Reason/Ailment______

Any history of medical problems or special circumstances we should be aware of or that in any way might effect and/or hinder your participation and/or performance of the Paddlesport Activities (as defined in the foregoing WESSELMAN NATURE SOCIETY ADULT WAIVER AND RELEASE OF LIABILITY)?

Physician/PH# ______

Hospital of choice ______

This release is completed and signed of my own free will with the sole purpose of authorizing medical treatment under emergency circumstances for myself. All information is true and complete.

Signed: ______Phone: ______by adult participant or guardian Address, city, zip: ______