ASSUMPTION OF RISK AND GENERAL RELEASE

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I am aware that during the kayak trip, or other activity in which I am participating or plan to participate under the sponsorship or arrangement of NANTASKET KAYAKS, INC., a Massachusetts corporation, certain risks and dangers may exist, including but not limited to, risks and dangers caused by travel, travel on open water, exposure to the forces of nature and possible accident or illness, or drowning.

I have read and understand this: _____________________(initial here)

In consideration of, and as part payment for, the right to participate in such activity and the services of NANTASKET KAYAKS, INC., I have and hereby do assume all of the above mentioned risks and dangers and will hold harmless NANTASKET KAYAKS, INC. and all or any or its owners, directors, officers, agents and employees from all actions, causes of action, suits and any and all claims, demands and liabilities whatsoever, both in law and equity, which against NANTASKET KAYAKS, INC. and/or any of its owners, directors, officers, agents and employees I now have or may acquire arising out of or in connection with such activity. I further agree to use prudent safety rules as set forth by my NANTASKET KAYAKS, INC. instructor(s).

Check the appropriate line:

__________ I am not aware of any aspects of my health history which would prohibit or complicate this activity for me.

__________ I am aware that the following aspects of my health could prohibit or complicate this activity for me:

I FURTHER RECOGNIZE THAT NO REPRESENTATIONS OR GUARANTEES ARE BEING MADE TO ME BY NANTASKET KAYAKS, INC. AS TO MY OWN PROFICIENCIES, LEVELS ATTAINMENT OR MY ABILITIES TO ENGAGE IN SIMILAR ACTIVITIES WITHOUT SUFFERING INJURY IN THE FUTURE.

The terms hereof shall bind my heirs, executors, administrators and assigns, and shall serve as an assumption of risk and general release for all members of my family, including any minor children, participating in such activity.

WITNESS my hand this _______ day of _________ 20___

Signature: ___________________________________

Parent co-signature: _________________________

(Print Name): __________________________________

Address: ______________________________________

City: ________________________________________

State: __________________ Zip ______________

Age_____ Home Phone: _______________________

Work Phone: _______________________________