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Fishing Club with Beyond Boundaries

Date

Tuesdays 

7.7

7.14 

7.21

7.28

 

Time

4-6 pm

 

Where

Bryan Park -  4308 Hermitage Rd, Richmond, VA 23227

Shields Lake - https://www.google.com/maps/dir/37+32+25.24+-77+28+29.24//@37.5395452,-77.5454356,12z/data=!4m6!4m5!1m3!2m2!1d-77.4747889!2d37.5403444!1m0?hl=en

 

We will provide bottled water only. 

Feel free to bring a snack

 

*Participant must have a fishing license - This is a lifetime license.

https://www.dgif.virginia.gov/forms-download/PERM/PERM-032.pdf

 

Cost

$10 per participant per date

$5 for any additional participants 

 

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Contact Information
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First Name
Last Name
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First Name
Last Name
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WAIVER
In consideration of being allowed to participate in any way in the program, related events and

activities, and use of equipment, I 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 paralysis and death.

2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF

ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full

responsibility for my participation.

3. I willingly agree to comply with terms and conditions for participation. If I observe any

unusual significant hazard during my presence or participation, I will remove myself

from participation and bring such to the attention of the nearest official immediately.

4. I, for myself and on behalf of my heirs, assigns, personal representatives, and next of

kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS the Host, it’s officers, officials,

agents, and/or employees, other participants, sponsors, advertisers, and if applicable,

owners and lessors of premises used to conduct the event (RELEASEES), from any and all

claims, demands, losses, and liability arising out of or related to any INJURY, DISABILITY

OR DEATH I may suffer, or loss or damage to a person or property, WHETHER ARISING

FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent

permitted by law.

Health Statement

I will notify Jacob’s Chance ownership or employees if I suffer from any medical or

health condition that may cause injury to myself, others, or may require emergency care

during my participation.

1365 Overbrook Rd,

Richmond, VA 23220

804-640-8109

info@jacobschance.org

Media Statement

By agreeing below, I hereby grant and convey to Jacob’s Chance all right, title and interest

in and to record my name, image, voice, or statements including any and all

photographic images and video or audio recordings made by Jacob’s Chance

Venue

The Venue of any dispute that may arise out of this agreement or otherwise between

the parties to which Jacob’s Chance or its agents is a party shall be either the Richmond

City, VA Justice Court, or the County or State Supreme Court in Richmond City, VA.

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Photo Release Form

Jacob’s Chance has my permission to use my or my child’s photograph publically to promote the organization. I understand that the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use.

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