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Town of Rye

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


Rye Town Park Beach Wheelchair Participation Waiver


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

Printed Name of Participant

Are you the Caregiver or Wheelchair User?

Signature of Participant

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Emergency Contact Name