Burlington County Freeholders
Paddle, Pedal and Pound the Path
October 28, 2006
Waiver/Registration Form

Each person kayaking, biking and running in the Paddle, Pedal and Pound the Path Triathlon challenge on the Rancocas Creek, the streets of Eastampton, Mt. Holly, and Historic Smithville Park must complete and sign this registration form before participating. Participants must be 18 or older. Each person must wear a Personal Floatation Device while kayaking at the Triathlon challenge.

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Last Name                                                                         First Name                                                                                                             Age

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Street Address                                                                                             City                                                                          State                 Zip

Phone number (  ) ______________

Waiver and Release of Liability

In consideration of Mick's Canoes & Kayaks; Burlington County Board of Chosen Freeholders, its agents and employees; The Eastampton First Aid Squad, Pemberton First Aid, Southampton First Aid and America Emergency Squad of Mt. Holly, DQ Events, and volunteers for the event, furnishing services and/or equipment to enable me to participate in the canoeing, kayaking, I agree as follows:

I fully understand and acknowledge that outdoor recreational activities have: (a) inherent risks, dangers, and hazards and such exists in my use of kayaking, biking and running equipment and my participation in kayaking, biking and running; (b) my participation in such activities and/or use of such equipment may result in injury or illness including but not limited to bodily injury, disease, strains, fractures, partial and/or total paralysis, death or other ailments that could cause serious disability; (c) these risks and dangers may be caused by the negligence of others, accidents, breaches of contract, the forces of nature or other causes. Risks and dangers may arise from foreseeable or unforeseeable causes including, but not limited to, trip recommendations including but not limited to weather, trail or river route location and water level and conditions, risks of falling out of canoe or drowning while in a canoe or kayak and such other risks, hazards and dangers that are integral to recreational activities that take place in the wilderness, outdoor or recreational environment; and (d) by my participation in these activities and/or use of equipment, I hereby assume all risks and dangers and all responsibility for any losses and/or damages, whether caused in whole or in part by the negligence or other conduct of the owners, agents, officers or employees of Mick' s Canoe &Kayak Rental; DQ Events , Burlington County Board of Chosen Freeholders, its agents and employees; The Eastampton First Aid Squad, Pemberton First Aid, Southampton, The America Emergency Squad of Mt. Holly, and volunteers for the event.

I, on behalf of myself, my personal representatives and my heirs hereby voluntarily agree, release, waive, discharge, hold harmless, defend and indemnify Mick's Canoe and Kayak Rental DQ Events ; Burlington County Board of Chosen Freeholders, its agents and employees; The Eastampton First Aid Squad, Pemberton First Aid, Southampton America Emergency Squad of Mt. Holly, Rancocas Creek Association, and volunteers for the event, from any and all claims, actions or losses for bodily injury, property damage, wrongful death, loss of services or otherwise which may arise out of my use of canoeing or kayaking equipment or my participation in canoeing, kayaking activities. I specifically understand that I am releasing, discharging and waiving any claims of actions that I may have presently or in the future for the negligent acts or other conduct by the owners, agents, officers or employees of Mick's Canoe & Kayak Rental; DQ Events, Burlington County Board of Chosen Freeholders, its agents and employees; The Eastampton First Aid Squad, Pemberton First Aid, Southampton America Emergency Squad of Mt. Holly, Rancocas Creek Association and volunteers of the event.

I HAVE READ THE ABOVE WAIVER AND RELEASE AND BY SIGNING IT AGREE. IT IS MY INTENTION TO EXEMPT AND RELIEVE MICK'S CANOE & KAYAK RENTAL; COUNTY OF BURLINGTON, BURLINGTON COUNTY BOARD OF CHOSEN FREEHOLDERS, ITS AGENTS AND EMPLOYEES; DQ EVENTS, THE RANCOCAS CREEK ASSOCIATION, AND VOLUNTTERS FOR THE EVENT, FROM LIABILITY FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH CAUSED BY NEGLIGENCE OR ANY OTHER CAUSE.

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Signature                                                                                                                                                         Date