JSSKA MEMBERSHIP REGISTRATION


To register or renew your membership in the Jersey Shore Sea Kayak Association, type in all information below and then print the page using the "PRINT" button of your browser. REMEMBER TO SIGN THE BOTTOM OF THE PAGE. Send completed form and dues for each member. Mail to: JSSKA c/o Sam Mikhail, 7-11 South Ave., Garwood, NJ 07027.  Be sure to include your check for annual dues ( $10 per person ) payable to Jersey Shore Sea Kayak Association.

Date:     EMail Address:

I am a New Member  I am Renewing my Membership   

 I am 18 years of age or older   I am under 18  
   
    Name:
  Street 1
  Street 2
        City:     State:     Zip Code    
   County
Phone (home):     (Cell-Mobile): Birth Year:
Rate your ability Beginner     Intermediate     Expert
How did you find out about JSSKA?

Emergency Contact Name and Phone Number:

In consideration of being allowed to participate in any way in the Jersey Shore Sea Kayak Association athletics/sports program, and related events and activities, the undersigned Agrees to the following:

1. Membership in JSSKA is open to individuals 18 years of age or older.  Individuals must be 18 years of age or older to participate in JSSKA padding trips,the JSSKA Message Board, camping trips, and events posted on the Paddlers Express Message Board.

2. Sea Kayaking can be a dangerous sport. JSSKA urges all participants to take ACA approved instructional courses, and to learn about safety, self-rescue, hypothermia, cold-shock, waterway navigation and basic USCG rules before launching on any trip. Paddlers should also be aware of current and future weather conditions and should never overestimate their abilities. I understand that I am solely responsible for my own safety and navigation at all times when participating in any and all paddling trips, events and activities posted on the club message board and calendar.  JSSKA assumes no liability.

  3. Prior to participating in any activity or event, I will inspect the facilities and equipment to be used, and if I believe anything is unsafe, I will immediately advise a coach, instructor, supervisor, or other event organizer of such condition(s) and I will refuse to participate.

4. I acknowledge and fully understand that I will be engaging in activities that involve risk of damage topersonal property or serious injury, including permanent disability and death, and severe social and economic losses which might result not only from my own actions, inactions or negligence, but the
  actions, inactions or negligence of others, the rules of play, the condition of the premises, or of any equipment used. Further, there may be other risks not known or not reasonably foreseeable at this time.

 5.  I assume all of the foregoing risks and accept personal responsibility for all expenses, medical or otherwise, following any such damages, injury, permanent disability or death.

6. JSSKA does not recommend consuming alcoholic beverages when paddling. JSSKA is not responsible for anyone who choses to consume alcohol at any JSSKA event, paddling trip, camping trip or related activity.

 7. .  I release, waive, discharge and covenant not to sue the Jersey Shore Sea Kayak Association, its affiliated clubs, their respective administrators, officers, agents, directors, and other employees of the organization, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners
and leasers of premises used to conduct the event, all of which are hereinafter referred to as "releasees", from any and all liability to me, my heirs and next of kin for any and all claims, demands, losses or damages on account of injury, including death or damage to property, caused or alleged to be caused in whole or in part by the negligence of the releasees or otherwise.

 8.  This waiver may not be modified in any way. If any part of this waiver is determined to be invalid by law, all other parts of this waiver shall remain valid and enforceable.


I HAVE READ THE ABOVE WAIVER AND RELEASE, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND I HAVE SIGNED IT VOLUNTARILY.

Signature:

Date:

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