Waiver and Permission Form

"*" indicates required fields

Camper's Name*
Date of Birth*


In consideration of your minor child being permitted to participate, wherever the Event and/or activities may occur, you hereby attest that, after reading this Sports Waiver and Permission Form completely and carefully, you acknowledge that participation in the Event/Activity by your child is entirely voluntary, and that you understand the inherent hazards and risks associated with surfing activities and all the ocean and shore activities conducted by HDOSSC and agree as follows:

PHYSICAL CONDITION/MEDICAL AUTHORIZATION: I hereby certify that my child is physically fit for participation in the event and/or activities conducted in conjunction therewith (the”Event/Activity”) and has the skill level required in conjunction with the Event/Activity, and I have not been advised otherwise. In connection with any injury sustained or illness or medical conditions experienced during my child’s attendance in connection with the Event/Activity, I authorize any emergency first aid, medication, medical treatment or surgery deemed necessary by the attending medical personnel if I am not able to act on my child’s behalf. Additionally, I authorize medical treatment for my child at my cost, if the need arises; however, I acknowledge that the Released Parties shall have no duty, obligation or liability arising out of the provision of, or failure to provide, medical treatment. For the purposes hereof, the “Released Parties” are all instructors, including Michael O’Shaughnessy, officers, employees, representatives, HDOSSC staff, volunteers and Board.

EQUIPMENT AND FACILITIES INSPECTION: I, or my child if I am not in attendance at the Event/Activity, will immediately advise the manager of any unsafe condition that I, or my child if I am not in attendance at the Event/Activity, observe. My child will refuse to participate, and I will refuse to let my child participate, in the Event/Activity until all unsafe conditions observed by me, or my child have been remedied.

PUBLICITY RIGHTS: I further grant the Released Parties the right to photograph and/or videotape me and my child and further to display, use and/or otherwise exploit me or my child’s name, face, likeness, voice, and appearance forever and throughout the world, in all media, whether now known or hereafter devised, and in all form including, without limitation, digitized images, whether for advertising, publicity, or promotional purposed, including without limitation, publication of Event/Activity results and standings, without compensation, reservation or limitation or further approval, and I agree to indemnify and hold harmless the Released Parties for any Claims associated with such grant and right to use. The Released Parties are, however, under no obligation to exercise any rights granted herein.

GOVERNING LAW: This Waiver and Permission Form shall be governed by and interpreted the laws of the State of Florida. By signing this agreement, you agree to waive and release any and all claims against the Released Parties, and you agree to waive certain legal rights, including your right to sue.

By signing this agreement, I confirm I have read it, I understand it, and I agree to be bound by it.

MM slash DD slash YYYY
Electronic Signature*
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