CHICAGO YACHT CLUB
LIABILITY RELEASE & WAIVER AGREEMENT
2013 Autumn Classic
By signing below, I agree to give up certain rights or potential rights relating to my participation in the
Autumn Classic, as explained below. This means, among other things, neither my family nor I will sue
if I am injured or die during the regatta. I also agree to allow the Club to use pictures of me. The
terms of my agreement are as follows:
Release of Liability. In consideration for my participation in the Autumn Classic (the "Race"), I, on
behalf of myself and my respective heirs, executors, administrators, personal representatives and next
of kin (collectively with me, the "Releasors"), hereby forever waive, release and discharge, the
Chicago Yacht Club, its affiliates, and their respective members, managers, employees, agents,
volunteers, sponsors, officers, directors, representatives, successors and assigns (each a "Released
Party") from any and all claims, demands, damages, judgments, executions, rights of action or causes
of action, present or future, whether the same be known, anticipated or unanticipated, which one or
more Releasors may have, or claim to have, against any Released Party resulting from death, personal
injury, property damage or other loss any Releasors may sustain as a result of my participation in any
sailing activity associated with the Race, other related activities (including land-based activities, such
as parties related to the Race), or the use of the Chicago Yacht Club's facilities.
THIS RELEASE IS INTENDED TO DISCHARGE EACH RELEASED PARTY FROM ANY AND
ALL LIABILITY CONNECTED IN ANY WAY WITH MY PARTICIPATION IN THE RACE,
EVEN IF THAT LIABILITY ARISES OUT OF NEGLIGENCE OR CARELESSNESS ON THE
PART OF ANY RELEASED PARTY.
Assumption of Risk. I hereby acknowledge that serious accidents occasionally occur during sailing
activities and that mortal or serious personal injuries and/or property damage or other loss may result
from participation in sailing activities. I hereby voluntarily assume these and all other risks
inherent to the sport of sailing, including the risk of injury or death.
Permission to Use my Likeness. I hereby grant the Chicago Yacht Club, its agents and assigns the
unconditional and perpetual right to publish and broadcast anywhere in the world for any purpose and
in any media the names and images of me relating to or arising from my participation in the Race or
any other related activities.
I am 18 years of age or older (if minor, see next section). I have read this Liability Release & Waiver
Agreement, fully understand its terms, and freely and voluntarily sign it:
Participant’s Signature:
Print Name: Date:
Boat Name (if applicable):
IF UNDER 18 YEARS OF AGE -- PARENT OR GUARDIAN
I represent and warrant that I am the parent and/or legal guardian of Participant and I agree, on
behalf of the Participant, to all terms in the above Liability Release and Waiver Agreement. I further
give permission to the Chicago Yacht Club and its agents to undertake and/or authorize any medical
treatment deemed necessary, in their discretion.
Parent’s/Guardian’s Signature:
Print Name: Date:
EMERGENCY MEDICAL INFORMATION
DATE___________________
Student Name: Date of Birth:
Address:
City: State: ________ Zip:
Home Phone:
Names of Parents/Guardians:
Emergency Contact Name:
Day Phone: Relationship:
Primary Care Physician:
Phone:
Insurance Carrier:
Name on Policy:
Policy Number:
Please list any allergies, medications, or medical history of note other concerns
below:
