PARTICIPANT RELEASE OF LIABILITY and IMAGE RELEASE PLEASE READ BEFORE SIGNING
In consideration of being allowed to participate in any way in the above competitions, related events and
activities, I, _____________________________________, the undersigned, acknowledge, appreciate, and
1. The risk of injury from the activities involved in the Genesis Adventures event is significant and includes,
but is not limited to, the following; drowning, near-drowning, sprains, strains, fractures, heat and cold injuries,
over-use syndrome, injuries involving vehicles, animal bites and stings, contact with poisonous plants,
accidents involving, but not limited to; paddling, climbing, biking, hiking, skiing, snow shoeing, travel by
boat, truck, car, or other convenience, and the potential for permanent paralysis and death. While particular
rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and,
2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, BOTH KNOWN AND UNKNOWN,
EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASES or others, and assume full
responsibility for my participation; and,
3. I willingly agree to comply with the stated and customary terms and conditions for participation. If,
however, I observe any unusual significant hazard during my presence or participation, I will remove myself
from participation and bring such to the attention of the nearest official; and,
4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY
RELEASE, INDEMNIFY, AND HOLD HARMLESS GENESIS ADVENTURES, Inc., their officers,
officials, agents and/or employees, The State of Connecticut, The State of New Jersey, The State of New York,
The Commonwealth of Massachusetts, The State of Virginia, The State of Pennsylvania, The State of Florida,
independent contractors, other participants, sponsoring agencies, sponsors, advertisers, volunteers, and if
applicable, owners and lessors of premises used to conduct the event ("Releasees"), WITH RESPECT TO
ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER
ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent
permitted by law.
5. I further state that I am in proper physical condition to participate in this event and am over 18 years of age.
Otherwise parental signature is required.
6. The Releasees reserve the right to postpone, cancel, or modify the event due to weather conditions or other
factors beyond the control of the releasees that might affect the health or safety of the participants. No refunds
will be granted.
7. I grant permission for the use of my name and or likeness related to my participation in any event conducted
by Genesis Adventures, Inc. I also grant the use of my voice and any and all recorded and or
filmed/video/photographed footage of me, and further waive all rights to any compensation, as a result of my
name or likeness being used in any way.
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY
UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY
SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
Signature ________________________________ DOB_____________