An Eco-Friendly Campground, Cabin, & Event Destination in Capon Bridge, WV Lake with white sand beach & wood fired sauna |
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(Each adult must fill out a separate form and be responsible for their children)
I, ______________________________________ [full name], of
__________________________________________________________________
[Driver's Full address as shown on Driver's License],
__________________________________________________________________
[Vehicle Make / Model and License Plate # including State],
acknowledge that I have been invited as a guest to enjoy the premises known as Buffalo Gap Camp and its natural surroundings ("Premises"). I am aware that outdoor activities (such as swimming, rock climbing, and hiking) and the use of any equipment, shelter, or other facilities (including, for example, tents, cabins, campfires, and grills) can be hazardous. I am also aware that natural occurrences (such as lightning, high winds, rainstorms, and flash floods) and wildlife (such as bears, snakes, and Yellow Jackets) can be unpredictable and dangerous, and that consuming animals, vegetation, water, and other substances found on or around the Premises can be harmful. I acknowledge that I have read and will adhere to the posted list of rules and cautions and further agree to abide by any rules or regulations and to follow any guidelines or instructions that the owners of the Premises may provide orally or in writing. I understand that adhering to the list of rules and cautions or abiding by such rules, regulations, guidelines, or instructions does not guarantee my safety. I hereby assume all risks of injury, loss of life, and damage to persons or property (including pets). I further release, indemnify, and hold harmless the owners of the premises, including without limitation Buffalo Gap Camp, B.K. Haynes Corp., B.K. Haynes, and any other Corporation or LLC member ("Owners"), from and against any and all liabilities, claims, demands, costs, losses, expenses, or compensation of whatever nature in connection with any loss, damage, or injuries to persons and property caused or sustained by me, members of my family, my guests, or pets.
I certify that I am the parent, legal guardian, supervisor, or responsible person of the following minor child(ren): __________________________________________________________________ [name(s), age(s)].
I assume all risks and responsibilities for the safety and well-being of such minor child(ren) and am entering into this Liability Waiver and Indemnity on behalf of such minor child(ren). In the event I become incapacitated or am unable to give instructions or otherwise make my wishes known, I give the Owners and any of their agents, representatives, or other persons acting on their behalf, full power and authority to make any decisions, contact any persons, or otherwise perform any actions that they may deem necessary and appropriate under the circumstances. I specifically understand and acknowledge that my giving of such authority does not create any obligation on the Owners to make any decisions, contact any persons, or otherwise perform any actions on my behalf. I hereby release, indemnify, and hold harmless the Owners from and against any and all liabilities, claims, demands, costs, losses, expenses, or compensation of whatever nature in connection with any action taken or not taken by them on my behalf.
This Liability Waiver and Indemnity is binding on me, my heirs, agents, personal representatives, successors, assigns, and other persons acting or purporting to act on my behalf. My estate or I will reimburse the Owners for any and all costs and attorneys' fees in defending any lawsuits or claims filed by me or on my behalf. In case of an emergency, please contact the following person(s):
_____________________________________________________ [Emergency contact: name, relation, phone #].
I have read the Liability Waiver and Indemnity statements above and the posted Rules & Cautions and agree to be bound by / adhere to them:
_______________________________ (signature) __________________ (date)
______________________ (mobile or home phone number)