I understand the inherent risk in participating in the activities of the SALTY FLYRODDERS OF NEW YORK, INC. ("the CLUB")., including fishing trips, of one day or longer, which the CLUB may make available to its members and guests. I understand that the CLUB activities may take me into remote areas, and that I may not be able to be promptly evacuated or receive proper medical care in the event of injury or disease. I further understand that I am solely responsible for all costs of medical treatment and transportation.
Intending to be legally bound, for myself, my heirs, executors, and administrators, except to the extent that indemnity insurance is available, I waive, release, indemnify, and hold harmless, the CLUB, its Officers, Board of Directors, and members, against any and all claims for personal injury, disease, death, and property damage or loss, that I may incur, arising out of or connected in any way with any and all the CLUB activities. I assume the risk of undertaking all the CLUB activities, including related travel.
In case of emergency, when reasonably feasible, contact:
name: ___________________________________________ relationship: __________________
phone: home ( ) _________________________ office ( ) _________________________
date: ___ / ___ 2006
signature: __________________________________________
print name: __________________________________________
address1: __________________________________________
address1: __________________________________________
home phone: ( ) ____________________________________
cell phone: ( ) ____________________________________
day phone: ( ) ____________________________________
e-mail: ____________________________________________