Download Report

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West!Virginia!2014!
Manual!Signup!Form!
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Who!|!all!incoming!seventh!and!eighth!graders!
What!|!West!Virginia!adventure!week!that!includes;!community!service,!caving,!hiking,!whitewater!
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rafting,!swimming,!overnight!hiking!and!a!whole!lot!of!fun.!
When(|!Depart!Saturday,!July!26!|!checkGin!7am,!Student!Center!lobby!|!buses!depart!@!8am!sharp.!
!!!!!!!!!!!!!!!Return!Saturday,!August!2!at!5:30pm.!!
!!!!!!!!!!!!!!!Check!website!for!updated!ETA!
Cost!|!$325!by!June,!after!$350!!!!!
Trip(contacts!|!Joan!x151,!!Sharon!x139!or!Steve!x133!!!!!!!
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Emergency!cell!phone!during!trip:!616.724.6218!(Joan)!
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ACE!Adventure!Resort,!Oak!Hill!WV!!!800.787.3982!
Must(haves!|!BHBC!medical!waiver!and!release!form!!!
!!!!!!!!!!!!!!!!!!!!!!!!!Waiver!forms!(separate!formsG!caving,!whitewater!rafting!&!pontoon!boats)!
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First!name:!________________________________________________!
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□Student!
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Last!name:!________________________________________________!!!!!!!!!!!!!!!!!!!!□!Leader!
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Phone!number:!____________________________________________!
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□ Volunteer!
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Email:!____________________________________________________!
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Grade!entering!in!the!fall!of!2014:!_______________!!!!!Male:!□
Female:
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Do!you!have!a!tent:!□(yes!!(□ no!!!!If!yes,!how!many!does!the!tent!sleep:!__________!
Do!you!have!an!extra!tent!to!share?!□(yes!!(□ no!!If!yes,!how!many!does!the!tent!sleep!:!_________!!
Can!you!swim!without!a!personal!floatation!devise?!□(yes!!(□ no!!!!!
!!!!
TGShirt!Size:!!!Large!(Youth)!!!!!!Small!(Adult)!!!!!!!Medium!(A)!!!!!!!Large(A)!!!!!!!XLarge!(A)!!!!!!XXLarge!(A)!
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Please!list!1G2!friends!you!would!like!to!be!in!group!with.!You!will!be!placed!with!at!least!one!friend.!
1._____________________________________!
2.!_________________________________!
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Please!return!this!form,!the!required!waivers!and!your!money!to!the!attention!of!Joan,!Jr!Hi!Dept!
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!!!!!!!!!!Blythefield!Hills!Baptist!Church!|!6727!Kuttshill!Dr!Ne!|!Rockford!MI!49341!|!616.866.9597!|!bhbconline.org,
West Virginia 2014 Waivers
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Please turn in all of these forms AS SOON AS POSSIBLE. It makes the check
in process run more smoothly if all the forms are in prior to departure.
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BHBC med from & waiver
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This must be filled out if a current form is not on file.
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A med form is valid for one year.
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ACE General Waiver
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Required for all rafters
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Please note the highlighted area
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ACE Lake activity waiver
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Required for water usage
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Lost World Caverns waiver
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Required for caving
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Pontoon Boat waiver
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Required for pontooning on Summerville Lake
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Parents are signing for their minor child
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Adults and students must have these forms on file.
If you have any questions on these forms please do not hesitate to call. Some
forms repeat but that is because they are used in different areas of the
adventure park.
Joan
Joan%Reichenbach
Junior%High0Administra6ve%Assistant
Blytheﬁeld%Hills%Bap6st%Church%|%6727%KuCshill%Dr%NE%|%Rockford%MI%49341
616.866.9597%x151
[email protected]/|/bhbconline.org
SAVE
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PERMISSION!FOR!PARTICIPATION!WAIVER!AND!RELEASE!
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Date______________"
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First"Name______________________________________"Last"Name_____________________________________"☐Male"
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Address___________________________________________________"City________________________"Zip________________"
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Phone"(_____)________________________"Birthday"(M/D/Y)____________________________"Grade____________________"
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Email____________________________________________"School_________________________________________________"
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Emergency"contact________________________________________________________________________________________"
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Home"Address"(if"different"than"above)________________________________________________________________________"
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H"Phone(_____)___________________________________"Cell(_____)______________________________________________"
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MEDICAL!INFORMATION!
Primary"Care"Physician________________________________________"Phone(_____)_________________________________"
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Date"of"last"tetanus________________""☐We"do"not"vaccinate.""Date"of"last"physical___________________________________""
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(needed"for"adults"only)"
Present"or"history"of:""
☐yes"☐no""Allergies?"If"yes,"list"and"describe"reaction"&"desired"treatment___________________________________________"
________________________________________________________________________________________________________"
☐yes"☐no""Asthma?"If"you"have"an"Asthma"Action"Plan,"please"attach"copy"and"keep"with"medications.""
☐yes"☐no""Diabetes"R"Please"indicate:""☐insulin"or"☐diet"managed""
☐yes"☐no""Convulsions/Seizure"activity"R"if"yes,"date"of"last"incident________________________________________________""
☐yes"☐no""Fainting"spells"R"if"yes,"date"of"last"incident____________________________________________________________""
☐yes"☐no""Heart"trouble""
☐yes"☐no""Bleeding"disorders""
☐yes"☐no""Hypertension"R"if"yes,"date/last""BP__________________________________________________________________"
☐yes"☐no""Migraines"R"if"yes,"frequency_______________________________________________________________________""
☐yes"☐no""Other_________________________________________________________________________________________"
☐yes"☐no""Mental"Health"diagnosis"–"please"describe"diagnosis"and"list"medications___________________________________"
________________________________________________________________________________________________________"
List"other"prescription"medications,"dosages"and"what"they"are"used""for_____________________________________________"
________________________________________________________________________________________________________"
☐yes"☐no" If"there"is"any"reason"why"you"might"have"reservations"concerning"your"child's"or"your"participation"on"a"trip,"
please"explain"to"assist"us"in"making"the"best"decisions"for"you"or"your"child__________________________________________"
________________________________________________________________________________________________________"
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INSURANCE!
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Name"of"Insurance"Co__________________________________________"Provider"Phone"#_____________________________"
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Policy"#"_______________________________________"Group"#___________________________________________________""
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Name"of"Card"Holder______________________________________________________________________________________"
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Birthday"(M/D/Y)"of"Card"Holder__________________________________________"Prescription"coverage?""☐yes"☐no"""
I!hereby!give!my!permission!(if"applicant"is"a"minor)"for"the"applicant"to"participate"in"the"BHBC"activities"and"trips"including"
transportation"from"and"to"BHBC."
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If!emergency!medical!procedures!or!treatments!are!necessary!during!the!event,!I"authorize"Blythefield"Hills"Baptist"Church"staff"
or"representatives"to"arrange"for"and"consent"to"the"procedures"or"treatment."I"recognize"that"any"medical"treatment"that"is"
provided"while"attending"a"Blythefield"Hills"Baptist"Church"activity/trip"will"be"paid"for"by"me"or"my"insurance"company."
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Waiver!and!release!of!liability:!In"consideration"of"the"minor’s"participation,"I"hereby"waive"and"release"the"officers,"agents,"
employees"and"volunteers"of"Blythefield"Hills"Baptist"Church"from"any"and"all"claims"that"I"or"my"minor"may"have"for"losses,"
damages,"or"injuries"arising"out"of"or"resulting"from"my"minor’s"participation"in"the"program,"whether"or"not"caused"by"the"
negligence"of"the"officers,"agents,"employees"or"volunteers"of"Blythefield"Hills"Baptist"Church."I"HAVE"READ"AND"VOLUNTARILY"
SIGNED"THIS"WAIVER"AND"RELEASE"OF"LIABILITY"AND"PERMISSION"FORM."
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I!verify!that!the!applicant!is!in!good!health!and!is!capable!of!participating!in!strenuous!activities,!and"when"necessary,"will"
tailor"activities"to"those"within"the"bounds"of"applicant’s"physical"health."The"applicant"also"agrees"they"will"cooperate"with"
leaders"and"other"staff,"and"applicant’s"behavior"will"be"honoring"to"God."
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_____________________________________________________________"""
______________________________""
(Print"name"of"applicant"(if"adult),"parent"or"guardian"(if"applicant"is"a"minor)"
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Date""
By"checking"this"box"I"verify"that"the"name"typed/written"above"represents"my"true"identity."
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Authorization!to!use!picture,!name,!voice!and!likeness:!I"hereby,"on"behalf"of"myself,"my"heirs,"executors"and"administrators,"
sell,"grant,"assign"and"deliver"to"Blythefield"Hills"Baptist"Church,"its"subsidiaries"and"affiliated"companies,"its"successors,"agents,"
licensees"and"assigns"(Blythefield"Hills"Baptist"Church),"and"those"acting"under"its"permission"or"upon"its"authority,"the"exclusive"
right"to"own,"copyright,"use,"reproduce,"publish,"license,"assign,"display,"retouch"and/or"alter"at"any"time"and"in"any"media,"now"
known"or"hereafter"developed"for"any"lawful"purpose,"photographic"and/or"audio"visual"materials"including"my"image"and"any"
recording"of"my"voice"associated"therewith,"and"to"make"any"changes"and/or"additions"thereto,"or"derivative"works"there"from,"
for"reproduction"and/or"publication"in"conjunction"with"either"my"own"or"fictitious"names,"testimonial"copy,"or"otherwise."I"
specifically"waive"and"surrender"any"claim"which"I"may"now"have"or"hereafter"have"that"use"of"the"work"referenced"above"would"
constitute"an"invasion"of"my"privacy."I"release"Blythefield"Hills"Baptist"Church"of"any"compensation"or"financial"claim"by"me"as"a"
result"of"these"recorded"images"or"said"project."
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I"hereby"warrant"that"I"am"of"legal"age"and"have"every"right"to"contract"in"my"own"name,"or"that"I"am"the"parent,"legal"guardian,"
or"authorized"agent"of"the"talent"whose"name"appears"below."I"state"further"that"I"have"read"this"agreement,"prior"to"its"
execution,"and"that"I"am"fully"familiar"with"the"content"thereof."
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This"contract"constitutes"the"entire"agreement"between"Blythefield"Hills"Baptist"Church"and"me"and"supersedes"any"and"all"other"
agreements,"statements,"representations"and"understandings,"whether"made"verbally"or"in"writing,"concerning"the"subject"
matter"of"this"agreement"and"may"only"be"modified"in"writing"signed"by"Blythefield"Hills"Baptist"Church."
☐
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Yes,"it"is"okay"to"use"picture,"name,"voice"and"likeness.""
No,"you"do"not"have"my"permission"to"use"picture,"name,"voice"and"likeness."
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______________________________""
(Print"name"of"applicant"(if"adult),"parent"or"guardian"(if"applicant"is"a"minor)"
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Date""
By"checking"this"box"I"verify"that"the"name"typed/written"above"represents"my"true"identity."
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Blythefield"Hills"Baptist"Church"|"6727"Kuttshill"Dr"NE"|"Rockford,"MI"49341"|"616.866.9597"|"bhbconline.org,
Revised"10/12"
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A Registered Natural Landmark
HC 34 Box 308
Lewisburg, WV 24901
304-645-6677 or 1-866-228-3778
Wild Cave Tour Guest Information Sheet
Name:
Date:
Address:
City, State, Zip:
Phone Number:
Emergency Contact - Name:
Phone Number:
Pertinent Medical Information (including any prescriptions medications that may be
needed or currently taken on a regular basis):
During the safety and information briefing, the following items were explained to me,
and I was given an opportunity to ask questions about anything I didn't fully understand.
• The proper use of (and need for) the safety equipment provided to me by Lost World
Caverns, including: Helmet, Headlight, Kneepads, and Gloves.
• The importance of wearing sturdy hiking boots, which I have provided for my own
use.
• The inherent dangers of extreme adventure activities, like wild cave expeditions, and
the importance of following the instructions of the guides to ensure my safety and
well being.
• That the West Virginia Cave Protection Act states: "An owner of a commercial cave
is not liable for an injury sustained by a spectator who has paid to view the cave,
unless such injury is sustained as a result of such owner's negligence in connection
with the providing and maintaining of trails, stairs, electrical wires or other
modifications, and such negligence is the proximate cause of the injury."
Signature:
Date:
If person signing is a minor, adult authorized to act as guardian and accompany me on
my behalf:
Date:
Acknowledgment of Risks, Assumption of Risks and Responsibility and Release of Liability
Warning: I / we signify by my (our) signature(s) below that I (we) can read, write, and speak the English language and have read and understand
everything in this document. There are significant elements of risk in any adventure, sports or activity associated with the outdoors, the presence or use
of motorized watercraft, including but not limited to pontoon boats, Triumph boats or watercraft and activities incidental thereto (referred to herein as
“activity”). Although we have taken reasonable steps to provide you with appropriate equipment and/or skilled staff so that you can enjoy an activity for
which you may not be skilled, this activity is not without risk. Certain risks cannot be eliminated without destroying the unique character of the activity.
The same elements that contribute to the unique character of the activity can be causes of loss or damage to equipment, or cause accidental injury, illness,
or in extreme cases, permanent trauma or death. For your safety, and that of other participants, prior to using a pontoon boat, Triumph boat or boat it is
important that you understand applicable boating laws and rights of way. We do not want to frighten you or reduce your enthusiasm for this activity, but
we do think it is important for you to know what to expect and to be informed of the inherent risks.
Acknowledgment of Risks: I acknowledge that the following describes some, but not all, of those risks: 1) Changing water flow, currents, wave action,
or boat wakes; 2) Collision with any of the following: the pontoon boat or Triumph boat upon which I am the operator or passenger, other participants,
other boats or watercraft, and manmade or natural objects such as logs, wood, or rocks; 3) Wind shear, inclement weather, lightning, variances and
extremes of wind, weather and temperature; 4) My sense of balance, physical coordination, ability to operate equipment, swim and/or follow directions;
5) Collision, capsizing, sinking or other hazard which results in wetness, injury, exposure to the elements, hypothermia, and/or drowning; 6) Getting in or
out of the craft; 7) Travel, including travel to or from the activity; 8) The presence of insects, snakes, animals, and marine life forms, 9) Equipment
failure or operator error; 10) Heat or sun related injuries or illnesses including sunburn, sunstroke, or dehydration; 11) Fatigue, chill and/or dizziness,
which may diminish my/our reaction time and increase the risk of an accident. I am (we are) aware that this activity may entail risks of injury or death.
I/we understand the description of these risks is not complete and that unknown or unanticipated risks may result in injury, illness, or death.
Express Assumption of Risk and Responsibility: I/we agree to assume responsibility for the risks identified herein and those risks not specifically
identified. My/our participation in this activity is purely voluntary. No one is forcing me/us to participate. I/we verify that I am (we are) physically fit,
can read and understand the English language of which this document is written, can speak and understand the English language fluently so as to
understand all verbal directions given by our employees and staff; not under the influence of alcohol or drugs at this time and sufficiently qualified,
trained and capable to participate in these activities. I/we do not have seizures, convulsions, heart problems, or any other medical conditions that could
jeopardize my/our safety during this activity. Therefore, I/we assume full responsibility for myself/ourselves, including any minor children, for which I
am (we are) responsible, for bodily injury, accidents, illness, death, loss of personal property, and expenses thereof as a result of any accident which may
occur. I/we elect to participate in spite of the risks. I am (we are) responsible for protecting my/our skin and eyes from the elements. I/WE AGREE
TO WEAR A U.S. COAST GUARD APPROVED PERSONAL FLOTATION DEVICE (LIFE JACKET) WHILE PARTICIPATING IN THE
ACTIVITY. THIS IS A BASIC SAFETY PRECAUTION AND IS REQUIRED. PARTICIPATION INCLUDES RIDING IN THE VESSEL.
I/we assume the risk(s) of personal injury, accidents and/or illness, including but not limited to sprains, torn muscles and/or ligaments; fractured or
broken bones; eye damage; burns; cuts, wounds, heart attack, scrapes, abrasions and/or contusions; dehydration, drowning, oxygen shortage (anoxia),
and/or exposure, head, neck, and/or spinal injuries, bite or attack by animals, insects or marine life; allergic reactions; shock, paralysis or death.
COVENANT OF GOOD FAITH: I/we recognize that you, provider of services, will operate under a covenant of good faith and fair dealing, but you
may find it necessary to terminate an activity due to forces of nature, medical necessities or other problems; and/or refuse or terminate the participation of
any person you judge to be incapable of meeting the rigors or requirements of participating in the activity. I/we accept your right to take such actions for
the safety of myself/ourselves and/or other participants.
AUTHORIZATION: I/we hereby authorize any medical treatment deemed necessary in the event of any injury while participating in the activity. I/we
either have appropriate insurance or, in its absence, agree to pay all costs of rescue and/or medical services as may be incurred on my/our behalf. I/we
agree to any film or photographs of me/us as participants, become your property and may be used for promotional or commercial purposes.
RELEASE: In consideration of services or property provided, I/we, for myself/ourselves and any minor children for which I am (we are) parent, legal
guardian or otherwise responsible, any heirs, personal representatives or assigns, agree that: SUMMERSVILLE LAKE MARINA, INC. AND/OR
LONG POINT SCUBA, INC. dba “SARGE’S DIVE SHOP” its principals, directors, officers, agents, employees and volunteers, their insurers and
each and every land owner, leasee, municipal and/or government agency upon whose property an activity is conducted and their insurers, if any, shall
have no liability of any nature for any and all injuries and/or damage to me and other persons or properties as a result of any acts, omissions or
negligence of the “owner” or any other person (including myself/ourselves) or entity and I/we hereby release and discharge owner and insurer, if any, for
any such damage or injuries.
I/WE HAVE READ THE WARNING, ACKNOWLEDGMENT OF RISKS, EXPRESS ASSUMPTION OF RISK AND RESPONSIBILITY,
COVENANT OF GOOD FAITH, AUTHORIZATIOIN, AND RELEASE OF LIABILITY. I/WE UNDERSTAND THAT BY SIGNING THIS
DOCUMENT I/WE MAY BE WAVING VALUABLE LEGAL RIGHTS. NO ONE UNDER THE AGE OF 21 CAN OPERATE, LEASE, OR
RENT A PONTOON BOAT TRIUMPH BOAT OR BOAT FROM “SUMMERSVILLE LAKE MARINA, INC. (BOAT DOCKS) or LONG
POINT SCUBA, INC. DBA “SARGE’S DIVE SHOP”. I/WE ACKNOWLEDGE THAT ALL DRIVER’S LICENSES ARE VALID AND ANY
AND ALL CREDIT CARD(S) OR DEBIT CARDS ARE IN GOOD CREDIT STANDING AND WILL COVER ANY AND ALL DAMAGES
CHARGED TO ME/US. IN ADDITION, I/WE AGREE TO PAY SUMMERSVILLE LAKE MARINA, INC. OR LONG POINT SCUBA, INC.
DBA “SARGE’S DIVE SHOP” A FEE OF $300 PER DAY PLUS 6% TAX FOR EACH DAY A/ANY PONTOON BOAT(S) OR TRIUMPH
BOAT (RENTAL(S)) IN MY/OUR USE (RENTAL) ARE INOPERABLE AS A RESULT OF MY/OUR MISUSE OR NEGLIGENCE. THIS
WOULD INCLUDE, BUT IS NOT LIMITED TO, BROKEN STEERING CABLE, BROKEN PROPELLER OR PROP, PARTS AND LABOR,
DOWNTIME, BROKEN SEAT(S), DAMAGED CARPET, DAMAGED FUEL SYSTEM OR ELECTRICAL COMPONENTS, BROKEN OR
DAMAGED LOWER UNIT, BROKEN OR DAMAGED GEAR BOX, BROKEN, CRACKED, OR DENTED HULL, SIDE PANELS, OR RAILS,
LOST OR BROKEN LADDER, LOST ANCHORS OR ROPES OR ANY OTHER DAMAGE THAT WOULD RENDER THE MACHINE(S)
NONRENTABLE OR UNSAFE TO OPERATE OR INOPERABLE I/WE ALSO AGREE TO PAY ANY AND ALL LAWYER’S FEES AND COURT COSTS FOR ALL PARTIES INVOLVED SHOULD I/WE DECIDE TO SUE OR TAKE ANY LEGAL ACTION AGAINST
SUMMERSVILLE LAKE MARINA, INC, OR LONG POINT SCUBA, dba “SARGE’S DIVE SHOP”.
NO ONE UNDER THE AGE OF 21 CAN OPERATE OR RENT A PONTOON BOAT OR TRIUMPH BOAT.
Signature (s) of Participant(s): Parents/guardians must sign for anyone under the age of 18 years old.
1. ______________________
2. _______________________
3. ______________________ 4. ___________________
5. ______________________
6. _______________________
7. ______________________ 8. ___________________
9. ______________________
10. _______________________
11. ______________________ 12. ___________________
Pontoon Boat / Triumph Boat Safety Check-Off List
Place an "X" or a "Mark" in each accompanying blank to signify that you understand and agree with each statement.
____I/we acknowledge that I/we can read and speak the English language fluently and understand all written and verbal directions.
____ I/we agree to not jump or stand on tables or furniture and to not lean on or pull on any rails or poles.
____ Pets, rock climbing gear, scuba gear and / or grills are not allowed onboard the pontoon or Triumph rental boat.
____ Alcohol and illegal drugs and the use thereof are not allowed on the rental pontoon boat or Triumph boat.
____I/we understand that No One Under The Age of 21 can operate or captain the rental pontoon boat or Triumph boat.
____I/we understand and agree to never tow or pull a water skier with the rental pontoon boat or Triumph boat or to NEVER take the pontoon boat
or Triumph boat up onto any shoreline or beach.
____I/we acknowledge that my/our credit card(s) is/are in good credit standing and that I/we will pay for any and all damages to my/our rental boat(s).
____I/we understand and agree that I/we must obey all boating laws and boating safety basics.
____I/we understand and agree to not pick up or take on any additional passengers aboard the pontoon boat or Triumph boat that I/we am/are renting.
____I/we agree to not overload the pontoon boat or Triumph boat and will keep the weight and numbers of passengers within the U.S. Coast Guard specification located on
the U.S. Coast Guard Decal or plate located on the console of rental boat(s). For added safety, ten people / pontoon boat or five people / Triumph boat.
____I/we understand and agree to not let anyone else borrow or operate the rental pontoon boat or Triumph boat that I/we am/are renting.
____I/we understand that I/we must never operate the rental pontoon boat or Triumph boat in water that is shallower than 8 feet because the prop, pontoons, and
lower unit can be bent, cracked, dented, or broken. Also, the rental boat could impact or strike rocks, boulders, stumps, logs, or the shoreline not only causing
damage to the vessel, but; possible injury or death to you and/or your family, friends, or guests.
____I/we understand that when we moor the rental boat with an anchor, I/we will anchor it with sufficient distance from other boats or watercraft, the shoreline
and any underwater structures such as rocks, boulders, and logs as to prevent the vessel from drifting or swinging into these structures and damaging the rental
boat or any other vessel or watercraft.
____I/we understand that when we moor the rental boat to buoys, I/we will tie the front (bow) and rear (stern) of the rental boat to two different buoys,
if possible, leaving sufficient distance between the vessel and the buoys to prevent the buoys from hitting the rental boat and damaging it.
____I/We understand that attaching two ropes from the bow and stern of the rental boat to two buoys helps to prevent the vessel from swinging around and
striking another boat or vessel, rocks, boulders, trees, and the shoreline which could damage the rental boat(s) or other people or vessels.
____I/we understand that if I/we keep trying to start the engine when the cylinders are flooded, I/we run the risk of damaging the starter and I/we agree to pay for
its repair should this happen. This cost includes payment for any "Down Time" at $300 per day plus 6% tax as outlined below plus parts, travel to buy the parts,
mileage, and labor for the repairs.
____I/we understand and agree that if I/we experience engine problems, that I/we will contact the marina staff with a cell phone or with the assistance from the operator
of another boat or vessel.
____I/we agree to pay for any damages sustained to the rental boat and any watercraft or vessel that tows our rental boat during the process of trying to
return the rental boat to the marina for repairs or inspection or fuel should the rental boat run out of gasoline.
____I/we understand and agree that if the Engine Warning Buzzer (Alarm) sounds, I/we will shut the engine off and seek help from the staff of the marina.
Running the engine in this situation can damage the engine.
____I/WE UNDERSTAND THAT SUMMERSVILLE LAKE MARINA, INC. AND LONG POINT SCUBA, INC. DBA “SARGE’S DIVE SHOP” RECOMMEND THAT EACH PASSENGER ON THE RENTAL BOAT WEAR A PERSONAL FLOTATION DEVICE (LIFE JACKET)
AT ALL TIMES FOR SAFETY.
____I/we understand that I/we must be alert to avoid obstacles in the water such as floating logs, trees, rocks, submerged stumps, swimmers, snorklers, scuba divers, and
trash. I will not pull up to rocks or cliffs to allow someone to exit or step off the boat because the boat can impact these structures or persons causing damages or injury.
____I/we understand and agree to keep at least 100 feet from other jet skis, and boats, and at least 200 feet from water skiers at all times so as to give me/us more
time to react to any and all potential hazards that might occur.
____I/we understand and agree to come no closer than 100 feet from a "Diver Down Flag" because scuba divers are in the water.
____I/we understand and agree to keep at least 100 feet from the shoreline, swimmers, sailboats, and anchored boats when the rental boat is moving.
____I/we understand and agree to operate the rental boat at "idle speed" in the "NO WAKE ZONES" on Summersville Lake.
____I/we understand and agree to not speed in fog or stormy conditions.
____I/we understand and agree that if I/we see adverse weather conditions forming (i.e. lightning, hail, strong winds, etc.), I/we will return to the marina immediately.
____I/we understand and agree that I/we am/are financially responsible for paying for any and all damage(s) sustained to the rental boat(s) during the time of
my/our rental. This includes, but is not limited to, any and all damages to the pontoons, panels, rails, motor, prop, lower unit, seats, electrical system, ladder, ropes,
canopy, hull, windshield and fuel system.
____I/we agree to pay for any damages that I/we cause to occur to any other watercraft, structures, or individuals while I/we rent the rental boat(s).
____I/we understand that I/we am/are financially responsible for paying for any "Down Time" that my/our rental machine(s) experience. Down Time is when a
rental boat is out of operation or non-rentable due to damages sustained during my/our rental usage of said vessel(s). The "DOWN TIME" rate per
rental boat by Summersville Lake Marina, Inc. or Long Point Scuba, Inc. is $300.00 per day plus 6% tax per rental boat and I/we agree
to pay this rate for each day that the rental pontoon boat or Triumph boat is out of commission and Summersville Lake Marina, Inc. or Long Point Scuba,
Inc. has my/our permission to charge to my/our credit card(s) or debit card(s) for this "Down Time" fee.
____I/we understand and agree that Summersville Lake Marina, Inc. or Long Point Scuba, Inc. can hold my/our driver's license(s), money, and/or credit
card(s) until any rent or damage fees are paid for in full by me/us, the rentee(s) whose signature(s) appear(s) below on this form.
____I/we understand and agree that Summersville Lake Marina, Inc. or Long Point Scuba, Inc. has my/our permission to charge to my/our credit card(s)
or debit card(s) the total amount of money judged payable by Summersville Lake Marina, Inc. or Long Point Scuba, Inc. dba “Sarge’s Dive Shop” for any damages sustained to the rental boat(s) that I/we rented.
____I/we understand and agree to pay for any and all monetary fines that I/we receive from any and all law enforcement individuals while renting the rental
boat(s). This includes any and all legal fees and court costs.
____I/we understand that "Boating Safety Education Classes" are available to the public through the Division of Natural Resources Law Enforcement Section
and all boaters are encouraged by Summersville Lake Marina, Inc. and Long Point Scuba, Inc. to take a course on boater safety.
You can call 1-304-558-2784 for more information on these classes or you can contact any DNR officer. Boater safety classes are also offered through
the U.S. Auxiliary Coast Guard.
NO ONE UNDER THE AGE OF 21 CAN RENT OR OPERATE THE PONTOON OR TRIUMPH BOAT(S).
Signatures:
Anyone under 18 years of age MUST have a parent / guardian to sign for them.
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