South Shore Zip Line Tour
South Shore Adventures SA
Liability Waiver

(Please PRINT and Bring With You. Read carefully, Fill in the Blanks and Initial each Item before Signing.)

____ I understand and agree to release from any liability whatsoever South Shore Adventures , all their officers, agents, and employees from any injury or death caused by or resulting from my and/or my family’s participation in the activities associated with the South Shore Zip Line Tour, whether or not such injury or death was caused by their negligence, either active or passive, from me or my family’s negligence, or from any other cause.

____I am physically fit and able to partake in the zip line.
____I am not pregnant.

____I do not have current back problems such as herniated disks, previous back or neck surgery, or limited mobility in raising my arms.

____I do not suffer from epilepsy or seizures of any type.

____I have not consumed drugs or other chemicals that could impair my ability to participate in the zip line tour.

____I understand that the zip line tour is a physically strenuous activity and that I will be exerting myself during the zip line tour and that if I am injured as a result of a heart attack, panic, hyperventilation, etc, that I expressly assume the risk of said injuries that I will not hold the above listed individuals or companies responsible for the same.

I ______________________________, hereby affirm that I have been advised and thoroughly informed of the inherent hazards of the canopy tour.

____ In consideration of being allowed to partake in the zip line tour, I hereby personally assume all risks in connection with the zip line tour for any harm, injury, or damage that may befall me while participating in the canopy tour, including all risks connected therewith, whether foreseen or unforeseen.

____I, for myself, my family, my heirs, and executors, promise not to sue South Shore Adventures SA if I or my family is injured for any reason, this is a release of liability. This is with the knowledge that South Shore Adventures SA promises to provide a tour that meets the international standards for a zip line operation as in Costa Rica.
Signature___________________________  Age__________PrintName ___________________________

Signature ___________________________ Age__________ Print Name __________________________

Signature ___________________________ Age__________ Print Name __________________________

Signature ___________________________ Age__________ Print Name __________________________

Signature ___________________________ Age__________ Print Name __________________________

Phone _______________________ Date of Trip ___________________ Time______________________

In case of an emergency, I understand that effort will be made to secure proper treatment. I hereby give permission for such treatment. My personal health and accident insurance covers any accident or illness which I may incur during this experience and I will personally guarantee any cost or other liability incurred during evacuation or treatment: please contact the following person in case of an emergency:

Name__________________________________ Phone________________________________

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