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Town of Rye

dreisner@townofryeny.com

222 Grace Church Street, Suite 302, Port Chester , NY, 10573, US

914-939-3075

Rye Town Park Beach Wheelchair Participation Waiver

RELEASE OF LIABILITY/PHOTO/VIDEO RELEASE (required)

I/we hereby for ourselves, our heirs, administrators, and assigns, waive and release any and all claims against the Town of Rye, the City of Rye, Rye Town Park, the Rye Town Park Commission, its employees, contractors, sponsors, and volunteers for any and all injuries and/or expenses incurred by me/us while using any related recreation equipment such as the Beach Wheelchairs during participation in clinics, classes, workshops, practices, training, rides.

By signing this form, you give consent to authorize the use of any photos and videos taken during the event for promotional purposes. You can opt out at any time by contacting ryetownpark@townofryeny.com.

Printed Name of Participant

Are you the Caregiver or Wheelchair User?

Signature of Participant

Choose how to sign

Date

Emergency Contact Name