This form must be read and signed before participation is permitted to take part in the Puddle World Championship events. By signing this agreement, the participant affirms having read it.

Release of Liability and Waiver Agreement

In consideration of my participation in the Puddle Duck World Championship events, I acknowledge, appreciate and agree that:

1. I risk bodily injury, including disability and death as well as the risk of damage to or loss of property;

2. I knowingly and freely assume all such risks, both known and unknown;

3. I, for myself, and on behalf of my heirs, assigns, personal representatives, and next of kin, hereby release, hold harmless and promise not to sue David "Shorty" Routh, John H Wright, anyone else involved in the Puddle Duck World Championship events, or any of its officers, directors, agents, employees, or members with respect to injuries or loss of property from my participation even though such injury or loss or property may arise out of negligence or carelessness on the part of the persons or entities mentioned above.

I have read this Release of Liability and Waiver Agreement, fully understand its terms and sign it freely and voluntarily.


Date: _____________________

Participants Signature: ____________________________


Participants Name (printed): _____________________________


Phone Number: ________________________ Email: ________________________

Address, city, state, zip:



Emergency Contact: _____________________________

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For Participants Under 18


Parent / Legal Guardian Signature:____________________________


Parent / Legal Guardian Name (Printed): ____________________________


Date:____________________________


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