321-868-1980
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REGISTRATION AND INDEMNITY AGREEMENT/FORM
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150 E Columbia Lane, Cocoa Beach, Fl 32931 Phone: 321-868-1980
Registration and Indemnity Agreement
Student Name:___________________________________________________________________________________
Date: ______________________ E-Mail: _____________________________________________________________
Mailing Address:
Street: _________________________________________________________________________________________
Street: _________________________________________________________________________________________
City: _______________________________________________________ State: ___________ Zip: _____________
Age: ______ Male: ____ Female: ____
Emergency Contact:
Name: _______________________________ Phone #: ____________________________________
Name: _______________________________ Phone #: ____________________________________
All students, and guardians of participating students, prior to enrollment and participation in the Ron Jon Surf School SM*, (referred to herein and after in this document as RJSS) MUST first read, then complete the following Indemnity and Acknowledgement Agreement.
I, _________________________________________ (Student Name) agree to assume all risks incidental to participation in surfing, water sports, and related activities associated with the RJSS. I hereby grant permission for myself or my child to attend the RJSS. I hereby release RJSS from any and all liabilities, claims, actions, damages, costs, and/or expenses, arising from or in anyway connected with my participation in all surf school related activities conducted by RJSS.
I hereby agree that RJSS, employees, and affiliates, are not responsible or liable for any injuries or damage resulting from my participation in any RJSS activities. I understand and acknowledge that surfing and other water sports and related activities are inherently dangerous activities. I acknowledge and assume any and all risk associated with the presence of any and all sea life that may be in the water or on the beach.
I assume the entire responsibility of the performance of the activities associated with this agreement. I further expressly agree to indemnify and hold harmless RJSS, Cocoa Beach Surfing School, LLC., and Ron Jon Licensing, Inc., their directors, officers, employees, and affiliate companies for any and all claims for injury to persons or damage to property or any other damages or losses by anyone, all of the foregoing to include all expenses and charges including attorney’s fees, which may arise out of, or in connection with, the activities associated with this agreement, or which are alleged to have arisen out of activity associated with this agreement.
Right To Photograph: By signing this agreement I hereby give my consent and approval to the RJSS, that they shall have the rights, without obtaining my further approval, to photograph, take motion pictures of, televise, or reproduce in any manner or through any media, images of myself, my child, and my legal guardians. RJSS shall have the right to, display, use, sell or license any such pictures or other reproductions for any purposes commercial or otherwise without monetary compensation to myself, my child or my legal guardian.
Yes ______ No _______ (Please Check One )
I hereby authorize any RJSS personnel to conduct any minor Medical First Aid that may be required for my child or myself.
Yes ______ No _______ (Please Check One )
I hereby authorize any Physician or Nurses selected by RJSS personnel to order and conduct medical or surgical procedures deemed necessary for myself or my child in an emergency situation. I understand that I will be responsible for all Hospital, Laboratory, and Doctor Fees.
Yes ______ No _______ (Please Check One )
I verify that I am in good health and am fully capable of participating in any and all strenuous activities associated with any RJSS activities. I fully understand that each participant must be a competent swimmer and acknowledge that I am a competent swimmer.
Student’s signature: _____________________________________________________Date: __________________
I, ____________________________________ (Guardian’s Name) as the parent or legal guardian of _______________________________ (Students name) give my permission for my child or Ward to participate in RJSS activities. I do understand and acknowledge the above stated risks associated with my child or Ward’s participation in surfing related activities with the RJSS.
Parent or Legal Guardian:__________________________________________________Date:___________________
