E-Signature Record 6a834eef-9d8b-4b4d-90af-b5c71eedc263


Summary
  • * Respondent Reviewed and Signed. The respondent reviewed the contents of their submission, provided contact information for verification, and signed the response.
  • * Signatory Verified. Signatory has verified the information submitted when Response was signed.
  • * Record Completed. All E-Signature Record requirements have been completed.
  • * Record Locked. E-Signature Record was automatically locked. The E-Signature Record fulfills all requirements.
  • * Record Sealed. All steps have been completed. E-Signature Record has been cryptographically signed and hashed.
Record Details
Submitted Form
Submitted Form ID
4969717
Submitted Form Version
33
Submitted Response
Response Submitted Datetime
2024-11-11 19:07:09
Record Checksum
0c398a490bcb170264bb57ee7165a046232dd63184f0cbc2c80adc8ceae196fb
Package Signature Hash
4088aa2679a8e84a72e6bb8878c0ffae88128ac72716c3f9b4c2710e5c6e0f9d
Custodian Signature Hash
d9fb31b14f7c915d8825fa8f601cb22abc28ee887e7d923e488325ebbec459dd
Events
Date-Time E-Signature Event
2024-11-11 19:07:09 Initialized. E-Signature Record created.
2024-11-11 19:07:09 Started. Respondent started reviewing submitted response.
2024-11-11 19:08:22 Endorsed. E-Signature Record signed by Respondent. The response was locked.
2024-11-11 22:53:28 Completed. E-Signature Record completed.
2024-11-11 22:53:28 Locked. E-Signature Record locked. No additional changes possible.
2024-11-11 22:53:28 Sealed. E-Signature Record sealed. Cryptographic controls generated for E-Signature Record.

Response in E-Signature Record

(Page 1 /3)

Logo

Code of Conduct


I recognize it is a privilege to participate in the Project Healing Waters Fly Fishing (PHWFF) program, and I recognize that my behavior during events is a direct reflection on the reputation of PHWFF and its good name. 
Therefore, I will always conduct myself in a manner that brings credit to PHWFF. I further understand that any behavior of mine that is recognizably unacceptable will not be tolerated, or condoned, by PHWFF.

While engaged in PHWFF activities, I am aware I must always conduct myself in a mature and responsible manner, so as not to bring discredit to PHWFF or any other organization or person. I will comply with instructions as issued by the PHWFF Leader, when on a PHWFF outing, and respect his or her authority during the event.

Failure to observe the provisions of this Code of Personal Conduct may result in termination of my association with PHWFF, without right of appeal.
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- I will adhere to the policies adopted by the organization and govern my actions accordingly.*
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Adult Hold Harmless Agreement

RELEASE AGREEMENT

 

In consideration of the privilege granted me to participate in the Project Healing Waters Fly Fishing, Inc. (“PHWFF”) programs (the “Programs”) as hosted by PHWFF and/or local affiliates thereof (collectively with PHWFF, the “Organizations”), I, the undersigned, in acknowledgment that I am doing so entirely upon my own initiative, risk and responsibility, do hereby, for myself, my heirs, executors, and administrators, agree to remise, fully release, hold harmless, and forever discharge the Organizations and each of their officers, directors, employees and volunteers, acting officially or otherwise, jointly and severally (collectively, the “Releasees”) from any and all claims, demands, actions or causes of actions, on account of my death or on account of any injury to me or my property while participating, or as a result of my participation, in the Programs. 

 

I fully understand that injury  may occur from any cause whatsoever, including, without limitation, the inherent risks and dangers involved in fly fishing (particularly while wading or boating), the negligence of any Releasee, the risk of exposure to the novel coronavirus or any evolution thereof (“Covid-19”) or the consumption of alcohol by me or others. The ability to participate in the Programs is of such value to me that I hereby choose to accept the foregoing risks, including serious and potentially life threatening injury or illness, long-term disability, and even death, in order to participate in the Programs. I further understand that any failure by me to comply with the Organizations’ guidelines, procedures, and protocols, in general and with respect to safety guidelines and/or COVID-19 protocols may result in my immediate expulsion from the Programs.

 

MEDICAL CARE:  In the event of injury to me while participating in the Programs, I hereby authorize any of the Releasees to seek on my behalf any necessary medical attention.

 

Covid-19:  I hereby agree, represent, and warrant that I will not participate in the Programs if I (i) experience symptoms of COVID-19, including, without limitation, fever, cough, loss of smell or taste, or shortness of breath, (ii) have a suspected or diagnosed/confirmed case of COVID-19, or (iii) have been exposed to any person who has a suspected or confirmed case of COVID-19. I agree to notify the relevant Program immediately if I believe that any of the foregoing access/use restrictions may apply within 72 hours of my participation in any Program. 

 

In addition, I acknowledge and agree that I understand and will follow each Program’s COVID-19 procedures, and further that the Program may revise its procedures at any time based on updated recommended guidance and protocols issued by the governmental and public health agencies and further agree that I will comply with such revised procedures. I acknowledge and agree that, due to the nature of the Programs, social distancing of 6 feet per person may not always be possible.  I fully understand and appreciate and acknowledge that my participation may, despite the Organizations’ reasonable efforts to mitigate such dangers, result in exposure to COVID-19.

 

COMPLIANCE WITH VA AND VAVS:  I understand that the Programs are being conducted in collaboration with the U.S. Department of Veterans Affairs (the “VA”) and the U.S. Department of Veterans Affairs Voluntary Service (the “VAVS”); or with the Department of Defense (the “DOD”). I agree to abide by, and act in accordance with, all applicable VA and VAVS or DOD rules, regulations or orders and all instructions or directions from the VA, VAVS or DOD and its affiliated agencies or their staff relating to my involvement in the Programs.

 

ASSUMPTION OF RISK AND WAIVER OF LIABILITY: I have read and fully understand the consequences of this Release Agreement, including that I give up my right to bring  any claims against Releasees including for personal injuries, death, disease, quarantine, property losses, or any other loss, and give up any right I may have to seek damages, whether known or unknown, foreseen or unforeseen.  I further attest that I am over 18 years of age and possess the capacity to enter into this Release Agreement.

 

SEVERABILITY:  If any term or other provision of this Release Agreement is determined by a court of competent jurisdiction to be invalid, illegal or incapable of being enforced by any rule of law or public policy, all other terms, provisions and conditions of this Release Agreement shall nevertheless remain in full force and effect.

I have read this Release Agreement and fully understand the consequences of this Release Agreement, including that it releases the Releasees from any and all liability on account of any injury to me or to my property. I further attest that I am over 18 years of age and possess the capacity to enter into this Release Agreement.  
- I have read this Release Agreement and fully understand the consequences of this Release Agreement, including that it releases the Releasees from any and all liability on account of any injury to me or to my property. I further attest that I am over 18 years of age and possess the capacity to enter into this Release Agreement.
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Media Release

PROJECT HEALING WATERS FLY FISHING INC. [PHWFF] FORM OF CONSENT FOR USE OF PERSONAL INFORMATION                                                                            AND VISUAL IMAGES


PHWFF is a national 501(c)(3) non-profit charitable organization registered with the State of Maryland. Project Healing Waters Fly Fishing, Inc. is dedicated to the physical and emotional rehabilitation of disabled active military service personnel and disabled veterans through fly fishing and associated activities including education and outings.


Consent Form

In consideration of the opportunities and services offered by PHWFF and my participation in
them, I agree to permit PHWFF to use pictures, photographs, and/or other visual images of me, and narrative material about me and my participation in the PHWFF programs, for its educational and promotional efforts and its website. I assign all rights, title and interest in and to the material and the copyright of the materials to PHWFF. 
I waive any right to inspect and approve the photos, or other images and narrative materials about me, and any advertising and promotional copy with which they are connected. I understand that the circulation of such materials could be nationwide and that there will be no compensation to me for the use of such materials by PHWFF.

I waive any claim and all causes of action I may have against the PHWFF for its use of the pictures, photographs or visual images and narrative material.

The rights and protections granted in this document may be exercised by PHWFF at any time without limitation.
My participation in the programs of PHWFF is voluntary and in my private capacity.

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- I have read this document and intend to be bound by it.
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Your Signature

I have read this Release Agreement and fully understand the consequences of this Release Agreement, including that it releases the Releasees from any and all liability on account of any injury to me or to my property. I further attest that I am over 18 years of age and possess the capacity to enter into this Release Agreement.
signature
Signature
initials
Initials
Allen
Name
D.
Initials
2024-11-11 19:08:22
Datetime (UTC)
Signatory
Allen (Respondent)
allendlung@gmail.com
209.177.114.7
50d111e4-5412-4a99-b0b7-29f3fb92dd76