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MOUNTAIN MADNESS TOURS

11624 93st Edmonton Alberta T5G1C9
Ph:7808859813
Email: info@mountainmadnesstours.com
Website: www.mountainmadnesstours.com

MEDICAL DISCLAIMER and MAJOR WAIVER

AGREEMENT, RELEASE OF LIABILITY AND ASSUMPTION OF RISK

MEDICAL STATEMENT FOR UNDERGOING OUTDOOR ACTIVITIES 

I hereby certify that I am not aware of and am not under treatment for any physical infirmity or chronic ailment or injury that would adversely affect my participation in this tour. I have normal vision or have corrective lenses and I am generally in good health and fitness:

I Agree

I HEREBY AGREE AS FOLLOWS:

PARTIES INCLUDED.  I understand that this Agreement, Release of Liability and Assumption of Risk includes Benjamin Robert Johnson, MOUNTAIN MADNESS TOURS its agents, associated entities, officers, shareholders, partners, employees, representatives, volunteers, independent contractors, subcontractors, sponsors, successors hereinafter collectively referred to in this Agreement, Release of Liability and Assumption of Risk as MOUNTAIN MADNESS TOURS. 

I Agree

RISKS CONTEMPLATED.  This Agreement is made in contemplation of all Outdoor activities, including but not limited to BIKE RIDING TOURS, Skydiving, Whitewater rafting, Wine tours, Mountain bike riding, Hiking, Sightseeing, Sporting competitions and events, Triathlons, Skiing and Snowboarding, Heli or Cat skiing or snowboarding, Sledding, Dog sledding and any rescue operations or attempts by MOUNTAIN MADNESS TOURS whilst participating or observing the Outdoor Activity chosen to be included within a MOUNTAIN MADNESS TOURS, Tour. 

I Agree

RELEASE FROM LIABILITY.  I hereby release and discharge MOUNTAIN MADNESS TOURS from any and all liability, claims, demands, or causes or action that I may hereafter have for injuries or damages arising out of my participation in Outdoor activities. 

I Agree

COVENANT NOT TO SUE.  I further agree that I WILL NOT SUE OR MAKE CLAIM against MOUNTAIN MADNESS TOURS for damages or other losses sustained as a result of my participation in Outdoor activities. 

I Agree

INDEMNIFICATION AND HOLD HARMLESS.  I also agree to INDEMNIFY AND HOLD MOUNTAIN MADNESS TOURS HARMLESS from all claims, judgments and costs, including but not limited to solicitor costs, and to reimburse them for any expense whatsoever incurred in connection with any action brought as a result of my participation in Outdoor activities. 

I Agree

ASSUMPTION OF RISK.  I understand and acknowledge that Outdoor activities are inherently dangerous and I EXPRESSLY AND VOLUNTARILY ASSUME ALL RISK OF DEATH OR PERSONAL INJURY SUSTAINED WHILE PARTICIPATING IN OUTDOOR ACTIVITIES  including but not limited to equipment malfunction from whatever cause, inadequate training, rescue attempts, or any other injury I may sustain. 

I Agree

PARTIES BOUND BY THIS AGREEMENT.  It is my understanding and intention that this Agreement, Release of Liability and Assumption of Risk be binding not only by myself, but on anyone or any entity, including my estate and my heirs, next of kin, executors, administrators and representatives that or who may be able to or does sue because of my injury or death.  It is further my understanding and agreement that this Release is intended and does in fact release MOUNTAIN MADNESS TOURS from any and all claims or obligations whatsoever arising in any way from my participation in Outdoor activities. 

I Agree

In entering into this Agreement I am not relying upon any oral or written representations or statements made by MOUNTAIN MADNESS TOURS with respect to the safety of Outdoor activities. 

I Agree

DURATION OF RELEASE.  It is my understanding and intention that this Release and Agreement be effective not only for my first tour but for any subsequent tour or activities in any way associated with MOUNTAIN MADNESS TOURS. 

I Agree

ENFORCEABILITY.  I agree that if any portions of this Agreement, Release of Liability and Assumption of Risk are found to be unenforceable or against public policy, that only that portion shall fall, but I specifically waive any unenforceability or any public argument that I may make or that may be made on behalf of my estate or by anyone who would sue because of my injury or death. 

I Agree

LEGAL RIGHTS.  It has been explained to me, and I understand, that by signing this document I am giving up important legal rights and it is my intention to do so. 

I Agree

I AGREE that any photographs or video taken by MOUNTAIN MADNESS TOURS remains the property of MOUNTAIN MADNESS TOURS and may be used for marketing purposes. 

I Agree

UNDERSTANDING/BINDING OF AGREEMENT.  I hereby certify that I have read and understand the contents of this document and I wish to be bound by its terms. 

I Agree

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Second Participant's Signature*
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Third Participant's Signature*
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Signature*
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Signature*
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Signature*
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Signature*
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Signature*
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Signature*
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Signature*
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Additional Questions
Do you have any special dietary requirements / sensitivities / allergies?*
No
Yes

If you have any special dietary requirements / sensitivities / allergies please list them here
Do you have any medical concerns or history below that may affect your ability to take part in this tour or would be useful information for Mountain Madness Tours to have in case of an emergency.*
No
Yes

Please list any medical concerns or history below that may affect your ability to take part in this tour or would be useful information for Mountain Madness Tours to have in case of an emergency.
ARE YOU UNDER MEDICATION OF ANY KIND AT THIS PRESENT TIME?*
No
Yes

If you are on any Medication please describe it here.

Please enter your Alberta health care card number, Drivers license number or ID above. Please also enter your travel insurance details if applicable. *
Reservation Information

Reservation Date *

Last Name of Reservation: *
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
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.


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