Name *

First Name

Last Name

I certify that my child is physically fit, has sufficiently prepared or trained for this activity, and has yet to be advised not to participate by a qualified medical professional. I certify that no health-related reasons or problems preclude my child’s participation in this activity. *

Confirm

In consideration of my application and permitting my child to participate in this activity, I hereby: (A) waive, release, and discharge from any liability, including but not limited to liability arising from the negligence or fault of the entities or persons released, for my child’s personal injury or actions of any kind which may hereafter occur. (B) Indemnify, hold harmless and promise not to sue the entities or persons included in participation from any and all liabilities or claims made as a result of participation in this activity, whether caused by the negligence of release or otherwise. I acknowledge that this activity may involve a test of my child’s physical and mental limits and carries with it the potential for serious injury. The risks include, but are not limited to, those caused by terrain, facilities, temperature, weather, condition of participants, equipment, lack of hydration, and actions of other people including, but not limited to, participants, volunteers, monitors, and/or producers of the activity. These risks are not only inherent to participants, but are also present for facilitators. I hereby consent for my child to receive medical treatment, which may be deemed advisable in the event of injury, accident, and/or illness during this activity. The Accident Waiver and Release of Liability Form shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law. *

Confirm

I certify that I have read and fully understand this document. I am aware that this is a release of liability, and I signed it of my own free will. *

Confirm

Emergency Contact *

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Name

First Name

Last Name