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EASTERN WATERCROSS ASSOCIATION

OFFICIAL EWA MEMBERSHIP FORM AND WAIVER AND RELEASE OF LIABILITY AGREEMENT 2008 Seasib

All Participants Must Fill Out The Following 

Name__________________________________________    Type of Membership                        Return to:

                                                                                                 Annual                             $75.00     Eastern Watercross Association

Address________________________________________   One Day                           $30.00      Scott D. Mosher

                                                                                                 AmateurAnnual*               $30.00     114 Beardsley Lane

City_______________ State______ Zip Code__________                                                              Ithaca, NY 14850

Telephone_____________________ Blood Type________   Date of Birth_____________________________ Age_________________

Occupation______________________________________   Sled Year/Make/Model _________________________________________

Team Name_____________________________________     Number Choice 1^st____________    2^nd___________  3^rd_______________

Sponsors & Awards_______________________________________________________________________________________________

_______________________________________________________________________________________________________________

In consideration of being granted a membership in the Eastern Watercross Association, hereinafter referred to as the EWA, and in consideration of being permitted to participate in practice and competition events sanctioned by the EWA:

1. I, for myself, my heirs, personal representatives and assigns, hereby release, discharge, and agree to hold harmless and indemnity the EWA, the promoters presenting sanctioned events, the owners and lessees of premises, and officers, directors, officials, representatives, agents, and employees of all of them, of and from all liability, loss claims, demands and possible causes of action that may otherwise accrue from any loss. Damage or injury (including death) to my person or property, in any way resulting from, or arising in connection with, or related to any sanctioned event, and whether arising while engaged in competition or in practice or in preparation therefore, or while preparing to depart the premises, or while upon, entering or departing from said premises, from any cause whatsoever, including without limitation, the failure of anyone to enforce rules and regulations, failure to make inspections, or the negligence of any persons. I know the risk and danger to myself and property while upon said premises or while participating or assisting in a sanctioned event, and I do so voluntarily and reliance, not upon the property, equipment, facilities and existing conditions furnished by others, but upon my own judgment and ability, and I thereby assume all risk for loss, damage or injury (including death) to myself and my property from any cause whatsoever and whether or not attributable to the negligence of others.

2. I hereby acknowledge that all rights, property and interest in any broadcast by radio, television, motion pictures, or transmission by printed media or the internet, or by any other means, of any sanctioned event at which I am present, as well as any receipts therefrom, and any transcription thereof, belong to the EWA for its exclusive and unlimited use.

3. I agree that the EWA or its assigns, on a non-exclusive basis, may use my name and pictures, including pictures of my racing equipment and pictures taken at any sanctioned event, for any purposes in any media.

4. I assume all responsibility for all charges, premiums and taxes, if any, payable on any trophies, prize money articles of value, or whatever else may be acquired as a result of my participation in EWA sanctioned events, including without limitation, social security taxes, unemployment insurance taxes, workers compensation insurance, income taxes and withholding taxes, and any other assessments by appropriate governmental authority.

5. I understand that a membership is subject to EWA rules in force at the time of the event.

6. I hereby declare that to the best of my knowledge and belief, I upon oath, state that all statements set forth in this application are true and correct.

IN WITNESS WHEREOF,  I have set my hand and seal this___________________ day of________________________________________, at________________________

Applicants Signature_________________________________________   

Signature of Witness__________________________________________________

                                                                                                                                Address____________________________________________________________

MINORS RELEASE

NOTICE IF UNDER 21 YEARS OF AGE or under age of majority in state or province of applicants residence, this application must bear the signature of a parent  (natural guardian) or legal guardian. Said signature shall acknowledge a waiver and release of any and all claims such parent or legal guardian may have. Further, said person declares under oath that they have read the foregoing Waiver and Release of Liability Agreement executed by the minor, and that he/she accepts the same in full and on behalf of the minor, him/herself, the minors heirs, personal representatives and assigns. I hereby declare  under oath that to the best of my knowledge and belief, all statements and information contained  in the foregoing application are true and correct.

IN WITNESS WHEREOF,  I have set my hand and seal this_____________ day of______________________________, at________________________________________

_______________________________________________

Signature of Parent or Guardian                 
 

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