In consideration of being allowed to participate in any way in Ichetucknee Family Grocery and Campsites Inc. equipment, or its related events and activities, I,: ____________________________ (print name here) the undersigned acknowledge, appreciate, and agree that:

1.)  

The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular skills, equipment, and personal discipline may reduce this risk of serious injury the risk does still exist: and, I affirm that I am physically fit and able to perform this activity, and;

2.)  

I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM NEGLIGENCE, and assume full responsibility for my participation: and,

3.)  

I willingly agree to comply with the stated and customary terms and conditions for participation.  If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of employees of Ichetucknee Family Grocery and Campsites Inc. or Ichetucknee Springs State Park immediately: and,

4.)  

I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS Ichetucknee Family Grocery and Campsites Inc. and Ichetucknee Springs State Park and, their officers, officials, agents, and/or employees, other participants, sponsoring agencies, advertisers, and if applicable, owners (Ichetucknee Springs State Park) and lessors of premises used for the activity of Ichetucknee Family Grocery and Campsites Inc., WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property associated with my presence or participation, WHETHER ARISING FROM NEGLIGENCE, OR OTHERWISE, to the fullest extent permitted by law.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, I FULLY UNDERSTAND ITS TERMS, & UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.  I ALSO UNDERSTAND THAT I AM RESPONSIBLE FOR ANY LOSS OR DAMAGE TO THE EQUIPMENT PROVIDED TO ME BY Ichetucknee Family Grocery and Campsites Inc. AND SHALL REPAIR OR REPLACE SUCH IF NECESSARY.

FOR PARENTS/GUARDIANS OF PARTICIPANTS OF MINORITY AGE
(UNDER THE AGE OF 18 AT THE TIME OF PARTICIPATION)

This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree his/her release as provided above of Ichetucknee Family Grocery and Campsites Inc., and, for myself, my child and our heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless Ichetucknee Family Grocery and Campsites Inc. and Ichetucknee Springs State Park from any and all liabilities incident to my minor, WHETHER ARISING FROM NEGLIGENCE, OR OTHERWISE, to the fullest extent permitted by law.

LIST CHILDREN BELOW:

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