R20, 2018-04-20

NOTE: Wisconsin Riverside Resort does not accept paper waivers, please submit electronically.

Liza'sLagoon Waiver Release

Please select who will be participating:

First Minor's Information

or


Second Minor's Information

or


Third Minor's Information

or


Fourth Minor's Information

or


Fifth Minor's Information

or


Sixth Minor's Information

or



I hereby assume all risks in using the Pond Facility and Pavilion voluntarily for myself and child. I indemnify, release from liability, agree to defend and hold harmless Wisconsin Riverside Resort and any of their officers, directors, employees, agents, insurance carriers and representatives for any accident, injury, illness, death, loss, theft, damage to person or property, or other consequences suffered by myself or my child’s use of the Pond Facility, including but not limited to, claims arising from or related to Wisconsin Riverside Resort’s negligence and/or products liability.

In the event that I or my child is injured, I agree to assume any financial obligation, either through my health insurance, or through some other means, for any medical costs that I or my child incurs. Wisconsin Riverside Resort assumes no responsibility for any medical expenses, injury, or damage suffered by me or my child in connection with my or my child’s use of the Pond Facility. I am aware of the potential dangers incidental to the use of the Pond Facility and Pavilion, that this is a release of liability, a waiver of my legal right to collect damages in the event of injury, death or property damage, and a contract between Wisconsin Riverside Resort and me, and I sign it of my own free will. I expressly agree that this release is intended to be as broad and inclusive as the State of Wisconsin will allow and that if any portion is held invalid, I agree that the balance shall, not withstanding, continue in full legal force and effect.

Parental/Guardian Consent: I certify that I am the parent or legal guardian of the above participant and that I am entitled to his or her custody and control. I do hereby give permission for the child to use the Pond Facility. I further certify that the child is in good health and has no physical or other impediment which would endanger him or her while using the Pond Facility. I realize that the child may be exposed to a risk of injury or death. I understand the dangers incidental to using the Pond Facility and the need for safety precautions, and I have discussed these dangers and the need for safety precautions with the child. I understand that there is NO LIFEGUARD ON DUTY AT ANY TIME and that the child must be accompanied by an adult at all times while in the Pond Facility.

I have read, fully understand and accept this Release, Waiver of Liability and Assumption of Risk for the use of Wisconsin Riverside Resort’s Pond Facility on his/her behalf.

POND SAFETY & RULES

Adult supervision required for anyone 12 & under

NO LIFEGUARD ON DUTY

Swim At Your Own Risk

No Pets Allowed

Life Jackets Are Available

No Diving, Pushing or Jumping off Inflatables

No Throwing Dangerous Objects

Clean Up After Yourselves

No Glass Containers

Please be Considerate to Others

We Reserve the Right to Ask Anyone to Leave for Any Reason

This waiver is good only for the date selected:

OR this waiver is good for the 2018 season:


Please enter your first and last name

Email Address


Click to Sign
Signature

By checking here, you acknowledge you have read and understand the above terms, and are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.