NIS-01/2019 Rev: 6/4/2022 WAIVER AND RELEASE OF LIABILITY READ BEFORE SIGNING: In consideration of being allowed to participate in any way in the North Island Snowdrifters’ programs, related events and activities, I (______________________), the Undersigned, acknowledge, appreciate, & agree that: 1. The risk of injury from the many of the activities is significant, including the potential for permanent paralysis & death, & while particular skills, rules, equipment, & 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 RELEASEES or others & assume full responsibility for my participation; and, 3. I willingly agree to comply with the stated & customary terms & conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation & bring such to the attention of the nearest official immediately; and, 4. I, for myself & on behalf of my heirs, assigns, personal representatives & next of kin, HEREBY RELEASE AND HOLD HARMLESS the North Island Snowdrifters, their officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, &, 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. 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, & SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. Participant Signature _________________________________________ Date: _________________ FOR PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT THE TIME OF REGISTRATION) This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent & agree to his/her release as provided above of all the Releases, &, for myself, my heirs, assigns, & next of kin, I release & agree to indemnify and hold harmless the RELEASEES from any and all liabilities incident to my minor child's involvement or participation in these programs as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by law. I also consent to allow medical treatment in the event of an emergency. (Parent/Guardian) _________________________________________ Date _________________ **Make checks payable to NIS & mail to: MJ Lau, 2396 Harcourt Drive, San Diego CA 92123 First & Last Name (Nickname) Sex Birthday Season Pass? Home Phone Cell Phone E-mail Address Mailing Address City Select items of interest that you would be inclined to participate in. Enter in activity box. State Zip Code How did you hear about us? Place * next to information not to publish in the Membership Directory. Volunteer Board Committee Trip Leader Condo Captain General Helper Leisure Travel Dining Theater Movies Cooking Wine Tasting Spa Outings Table Games Active Sports Down Hill Ski Cross Country Ski Snowboard Cycling Hiking Camping Walking Dancing Ball Sports Golf Tennis Softball Volleyball Racquetball Pickleball Bowling Pool Water Sports Water Ski Rafting Kayaking Fishing Snorkeling Scuba Surfing Boating **Member Dues: $50 2022-2023 Membership Application Form Emergency Contact Name & Relationship (Parent, Child, Spouse, etc.) Emergency Contact Phone