Relase Form

Ask a staff member what to enter
Today's Date:
Thu Apr 25 2024 09:55
Practitioner:*
Lake Moultrie Kayak rentals and tours
Please read and answer
Age Limits*
By checking this box I am stating I am 14 years of age or older
Swimming
By checking this box I certify I can swim
life vest
I will wear a life vest while on the kayak
release
I release Lake Moultrie Kayak Rentals and tours, its employees, contractors, business owners and property owners from any and all liabilities
loss or damage
If I damage or loose a paddle, I will pay a replacement fee of 50.00, if I damage or loose a kayak I will be charged up to an $800 replacement fee.
If any provision, section, subsection, clause or phrase of this release is found to be unenforceable or invalid, that portion shall be severed from this contract. The remainder of this contract will then be construed as though the unenforceable portion had never been contained in this document.
Client Information
I hereby declare that I am of legal age (with valid proof of age) and am competent to sign this Agreement or, if not, that my parent or legal guardian shall sign on my behalf, and that my parent or legal guardian is in complete understanding and concurrence with this agreement.
Legal Name:*
Pronoun:
Chosen name:
Address:
Postcode:
Date of birth:*
If you are under 18 your parent/guardian will be required
Phone #:*
Email:*
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Signature:*


Emergency Contact
If something happens, your emergency contact might need to explain your medical history, allergies, or medications.
Name:
Phone #:
Photo ID*
Please take photo(s) of your government issued photo IDs and related paperwork.