PARTICIPANT RELEASE OF LIABILITY, WAIVER OF CLAIMS, ASSUMPTION OF RISKS, and INDEMNITY AGREEMENT Worthington Fly Fishing, Shasta Trout This is an assumption of risk document.  Please read it carefully and sign the form below. This risk form essentially says that I know I am going fly fishing which is an outdoor activity in a rural area. I acknowledge that I have voluntarily chosen to go on this fly fishing trip with Worthington Fly Fishing and certify that I have the necessary skills and abilities to participate in these activities.  I know and fully understand that fly fishing is an outdoor activity in a rural area and involves dangers and hazards both known and unknown where accidents can occur, participants can die, sustain injuries and property damage. These dangers, risks and hazards include, but are not limited to, water hazards in boating, float tubing, and wading in lakes and rivers and include drowning, hiking in rugged country, and injuries from fly fishing equipment, and other fishermen, insects and wildlife, inclement weather, and the lack of immediate medical attention in the event of injury. My participation in this activity is purely voluntary and I elect to do so at my own risk in spite of the risks and hazards. In consideration for Worthington Fly Fishing allowing me to participate in this fly fishing trip and signing this document, I fully recognize and understand that if I (or any minors on whose behalf I am signing this form) am/are hurt, die, or my property is damaged, I am solely and completely assuming the risk associated with these activities. As a parent or legal guardian of a participant under 18 years of age, I have read and voluntarily agree that said minor may participate in this fly fishing trip, and. Also, I give Worthington Fly Fishing permission to treat said minor in case of illness, injury, or accident. Worthington Fly Fishing reserves the right to decline service to any person it judges incapable of meeting the rigors and requirements of participating in fly fishing activities. I understand that fly fishing is a sport and there is no guarantee that fish will be caught. I also agree to follow all rules regulations and instructions both verbal and in writing from Worthington Fly Fishing and have reviewed and understand their policy on canceled trips and refunds and agree to all the stated conditions. I have read this document. I understand that this is a full and complete assumption of risk on my part, not only on my behalf but also on behalf of my heirs, all family members, representatives, and assigns. I voluntarily submit my name and email address in lieu of my signature as evidence of my acceptance of the above provisions. *

Full Legal Name *

First Name

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Minors Name

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Minors Date of Birth

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Electronic Signature Consent *

By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.

I consent to the use of an electronic signature.

Today's Date *

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