Block Island Club Adult Waiver of Liability

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Signee's Name (1) *

First and last name

Partipant's Name (2)

First and last name

Partipant's Name (3)

First and last name

Partipant's Name (4)

First and last name

Primary Email *

Signee's Date of Birth *

YYYY

I certify that I am 18 years of age or older

Required

Today's Date *

YYYY

Acknowledgement of Waiver
*

By signing, I agree that I have read and fully understand the Adult Waiver of Liability. I hereby agree that should any clause, portion or part of the Adult Waiver of Liability, as outlined above, be held invalid by a court of competent jurisdiction, the remainder of the agreement remains in full force and effect. I hereby acknowledge that I have read and understand the entire Adult Waiver of Liability agreement as outlined above, including all four parts thereof, and my signature indicates the same. My signing this acknowledgement is my free act and deed.

Option 2

Required

Acknowledgement of Electronic Signature
*

By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.

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