EVENT DETAILS & REGISTRATION: • Date: Saturday, June 26, 2021 • Time: 9 AM and 2 PM; Divers must arrive at 8:30 AM to board the dive charters. • Location: Boynton Harbor Marina -735 Casa Loma Blvd., Boynton Beach, FL 33435. • Registration fee: $75 per person and includes a 2-tank dive on one of the participating commercial dive charters: Loggerhead Dive Charters, Splashdown Divers, Starfish Scuba. This is a special rate that is being offered specifically for the Lionfish Derby. Space is limited and will be offered on a first come first serve basis. All diving and lionfish hunting equipment must be rented or purchased separately. • Breakfast: The registration fee includes a gourmet breakfast sandwich and coffee or juice from Marina Café on the morning of the derby. • Requirements: Divers must register in 2-person teams. Individual divers who do not have a partner can contact the Boynton Beach Dive Center at (561) 732-8590 to see if they can be matched with another solo diver. Registration forms will not be accepted unless two divers are listed. • Payment: Divers must submit registration documents and payment (cash, check, or money order made out to Boynton Beach CRA) directly to the Boynton Beach Dive Center, located at 212 S. Federal Highway, Boynton Beach, FL 33435. MANDATORY DIVERS’ MEETING: • Date: Friday, June 25, 2021 • Time: 6 PM • Location: Boynton Harbor Marina – Dockmaster Building PRIZES & AWARD CEREMONY*: • Prize categories: Most lionfish, largest lionfish, and smallest lionfish • Prize selections: 2-tank dives on commercial dive charters, tank fills, gift cards and certificates to local restaurants and businesses, and other prizes. • Award Ceremony: June 26th at 3:00 PM at the Boynton Harbor Marina. For questions related to participating as a diver, call (561) 732-8590. For general event questions, call (561) 600-9097 or email [email protected]. *City and CRA staff, Commissioners and Board Members may participate in the Derby; however, they are not eligible to receive gifts or prizes. 01123344-1 ROCK THE MARINA & LIONFISH DERBY REGISTRATION FORM DIVER 1 TEAM NAME (2 DIVER MAX) ____________________________________________ FULL NAME__________________________________________________________ PHONE NUMBER _____________________________________________________ ADDRESS ___________________________________________________________ CITY _________________________ ZIP __________________________________ E-MAIL ADDRESS ____________________________________________________ DATE OF BIRTH _____________________________________________________ DIVE CERTIFICATION AGENCY_________________________________________ DIVE CERTIFICATION NUMBER ________________________________________ T-SHIRT SIZE________________________________________________________ WOULD YOU LIKE TO DONATE YOUR COLLECTED LIONFISH FOR RESEARCH? YES NO BREAKFAST SANDWICH (SELECT ONE): ___ EGG & CHEESE ___ BACON, EGG, & CHEESE ____ SAUSAGE, EGG, & CHEESE BEVERAGE (SELECT ONE): ____ ORANGE JUICE ____ COFFEE ____ COLD BREW I hereby understand and agree that my participation in the Rock the Marina & Lionfish Derby is voluntary and at my own risk. I hereby agree to hold harmless and indemnify the sponsors, City of Boynton Beach, and the Boynton Beach CRA for any personal injury or damages which may be occasioned to me or my property as a result of my participation in the Rock the Marina and Lionfish Derby event. SIGNATURE ________________________________________________________ PRINT NAME ________________________________________________________ DATE ______________________________________________________________ 01123344-1 Rock the Block Indemnification & Waiver of Liability Rock the Marina & Lionfish Derby (Event) will be held Saturday, June 26, 2021, from 9:00 A.M. to 5:00 P.M. at 735 Casa Loma Blvd., Boynton Beach, FL 33435. This Indemnification and Waiver of Liability Agreement is my acceptance that I, my spouse, my heirs, executors, and any assigns, hereby forever release, discharge, waive, and agree to hold harmless the Boynton Beach Community Redevelopment Agency (CRA), its officials, agents, instructors, employees, and volunteers from any and all claims, loss, cost, expense, suits, demands, causes of action of any kind whatsoever, which I or my spouse, heirs, executors, or assigns have, may have, or claim to have, known or unknown, as a result of any losses, damages, or injuries, including death, which may be sustained or suffered, directly or indirectly, including injuries or damage to person or property, including death, arising out of or in any way connected with my attendance or participation at the Event. I also agree that I personally shall indemnify, save, and hold harmless the CRA, its agents, officials, volunteers, instructors, and its employees from any liability, claim, demand, suit, loss, cost, expense, damage, or cause of action which may be asserted, claimed, or recovered against or from the CRA, its agents, or its employees, by reason of any property damages or personal injury, including death, sustained by any person whomsoever, which damage is incidental to, occurs as a result of, arises out of, or is otherwise related to the negligent or wrongful conduct or the faulty equipment (including equipment installation and removal) of the undersigned individual or the Company, Group, or Act indicated below. I warrant and assert that I have the authority to make enter into this Agreement on behalf of the Company, Group, or Act indicated below. Nothing in this Agreement shall be deemed to affect the rights, privileges, and sovereign immunities of the CRA as set forth in Section 768.28, Florida Statutes. This paragraph shall not be construed to require me to indemnify the CRA for its own negligence, or intentional acts of the CRA, its agents or employees. Each party assumes the risk of personal injury and property damage attributable to the acts or omissions of that party and its officers, employees and agents. Signed this day of , 2021. Signature: Print Name: Address: City: State: Zip Code: Telephone: Cell Number: Email Address: 00808731-1 Release of Liability/Assumption of Risk/Non-Agency Acknowledgement form Equipment Rental Agreement Please read carefully and fill in all blanks before signing This agreement is entered in between Boynton Beach Dive Center and ______________________for the Rental of scuba and/or skin diving equipment. This Agreement is a release of my rights and the rights of my heirs, assigns or beneficiaries to sue for injuries or death resulting from the rental and/or use of this equipment. I personally assume all risks of skin and/or scuba diving whether foreseen, related in any way to the rental and /or use of this equipment. Liability Release and Assumption of Risk Agreement: I understand and agree that Boynton Beach Dive Center, and its employees, owners, officers, contractor, assigns or agents (hereinafter referred to as “Released Parties”), shall not be held liable or responsible in any way for any injury, death or result of product defect, or the negligence of any party, including the Released Parties, whether passive or active. I hereby acknowledge receipt of the equipment designated in this form, and, if any of this equipment is to be used for scuba diving I affirm that I am a certified scuba diver or student diver in a scuba diving course/program under the supervision of a certified scuba instructor. I affirm it is my responsibility to inspect all of the equipment and acknowledge it is in good working condition. I affirm that it is my responsibility to check both the quality and quantity of gas in any scuba tanks. I acknowledge that I should not dive if the equipment is not functioning properly. I will not hold the Released Parties responsible for my failure to inspect the equipment prior to diving or if I choose to dive with equipment that may not be functioning properly. I understand that skin diving and scuba diving are physically strenuous activities, that I will be exerting myself during these activities and that If I am injured as a result of heart attack, panic, hyperventilation, drowning or any other cause, that I expressly assume the risk of said injuries and that I will not hold the Released Parties responsible for the same. I agree to reimburse the Dive Center for the loss or breakage of any and all equipment at current replacement value and to also pay for damages incurred while transporting the equipment. I agree to return the equipment in clean condition and to pay a cleaning fee if not returned cleaned. I further state that I am of lawful age and legally competent to sign this liability release, or that I have acquired the written consent of my parent or guardian. I understand the terms herein are contractual and not a mere recital, and that I have signed this Agreement of my own free act and with the knowledge that I hereby agree to waive my legal rights. I further agree if any provision of this Agreement is found to be unenforceable or invalid that provision shall be severed from this Agreement. The remainder of this Agreement will then be construed as though the unenforceable provision had never been contained herein. I understand and agree that I am not only giving up my right to sue the Released Parties but also any rights my heirs, assigns, and beneficiaries may have to sue the Released Parties resulting from my death. I further represent I have the authority to do so and that my heirs. assigns, and beneficiaries will be estopped from claiming otherwise because of my representations to the Release Parties. I,