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Ascending Path 

Acknowledgement of Risk & Waiver

Today's Date: October 19, 2018

ACKNOWLEDGMENT OF RISKS & RELEASE OF LIABILITY

PLEASE READ, UNDERSTAND, & SIGN THESE POLICIES

BEFORE SUBMITTING YOUR APPLICATION TO ASCENDING PATH LLC

In consideration of the services of Ascending Path LLC, its officers, agents, employees and stockholders, and all other persons or entities associated with those businesses (hereinafter collectively referred to as ("APLLC"), I agree as follows: Although APLLC has taken reasonable steps to provide me with appropriate equipment, skilled guides and instructors so I can enjoy an activity for which I may not be skilled, APLLC has informed me this activity is not without risk. Certain risks are inherent and cannot be eliminated without destroying the unique character of the activity. These inherent risks are some of the same elements that contribute to the unique character of this activity and can be the cause of loss or damage to my equipment, or accidental injury, illness or in extreme cases, permanent trauma or death. APLLC does not want to frighten me or reduce my enthusiasm for this activity, but believes it is important for me to know in advance what to expect and to be informed of the inherent risks. Some, but not all of these dangers are: riding in: a train, kayak, helicopter and/or a vehicle to and/or from the activity trailhead, the hazards of traveling in mountainous terrain and on glaciers, such as crevasse, rock, ice or other falls, altitude sickness, cold water emersion, hypothermia, equipment failure, avalanche and icebergs rolling.

Additional dangers may include vehicle accidents due to driver, passengers, nature, malfunction, another vehicle accident and/or collision to my transport vehicle, illness in a remote setting without timely (hours and/or days) medical evacuation to medical facilities and the communications to provide such services as well as forces beyond the control of APLLC such as the forces of nature, man, war, terrorism, flood, famine, bear, moose, vermin, insects or other wild beasts and any other force of nature. I am aware that mountaineering, water sports, rock climbing, trekking/hiking, glacier travel, ice climbing, skiing, winter camping and wilderness experiences entail risks of injury or death to any participant. I agree that I am able to independently participate in all individual skills and activities expected while also maintaining an appropriate and safe body position.

I understand that this description of these risks is not complete and that other unanticipated inherent risks, negligence, or instructional error may result in injury or death. I agree to assume and accept full responsibility for the inherent risks identified herein and those inherent risks not specifically identified. My participation in this activity is purely voluntary, no one is forcing me to participate, and I elect to participate in spite of and with knowledge of the inherent risks. I acknowledge that APLLC has no control over and assumes no responsibility for the actions of any independent contractors providing any services for the Trip.

I acknowledge that engaging in this activity may require a degree of skill and knowledge different than other activities and that I have responsibilities as a participant and if I do not fulfill these requirements at any time for such reasons that would jeopardize the safety or increase the inherent risks of the agreed upon activity, APLLC has the right to cancel the trip or not allow my participation based on their knowledge and experience of the activity and its nature. Some, but not all the participant refusals and trip cancellations are, but not limited to: guide's and instructor's judgment, incomplete and uncompleted participation agreement, lack of proper attire and preparedness, health and medical conditions, physical ability, dangerous conditions, weather, impairment from alcohol or substances and others not herein named. I also acknowledge that there is a chance the environment I will be in can effect the efficacy of any prescription drugs I am taking. I should consult my doctor prior to participation in this activity to determine whether this activity is suitable for my condition. I acknowledge that APLLC has been available to more fully explain to me the nature and physical demands of this activity and the risks, hazards, dangers and potential outcome associated with this activity. I certify that I am fully capable of participating in this activity and may be pushed to my fullest capacity. Therefore, I assume and accept full responsibility for myself and all minor children in my care, custody and control, for bodily injury, death or loss of personal property and expenses as a result of those inherent risks and dangers identified herein and those inherent risks and dangers not specifically identified, and as a result of anyone's negligence in participating in this activity. I agree that I meet APLLC's Essential Eligibility Criteria as described online.

I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, hereby irrevocably and unconditionally release, indemnify, and hold harmless Ascending Path LLC, and its officers, officials, agents and/or employees, other participants, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the events (releasees) including Alaska Railroad Corporation, from any and all liabilities, claims, demands and losses arising out of or relating to any injury, disability or death I may suffer, or the loss or damage to person or property, whether arising from the negligence of the releasees or otherwise, to the maximum extent permitted by law.

Arbitration
Any claim or controversy arising out of or relating to the agreement or the performance there under, including without limitation any claim relating to illness, injury or death, shall be settled by binding arbitration in Alaska in accordance with the rules of the American Arbitration Association then existing and the Laws of Alaska State, and the judgment on the arbitration award, including reasonable attorney fees, may be entered in any court having jurisdiction over the subject matter of the controversy. This agreement to arbitrate does not waive or modify the liability release contained in the foregoing paragraph. I have carefully read, clearly understood and accepted the terms and conditions stated herein and acknowledge that this agreement shall be effective and binding upon myself, my heirs, assigns, personal representatives and estate and for all members of my family, including minor children.

First Participants Name

First Name*

Last Name*
First Participants Date of Birth*
First Participants Information

Please note that any and all information provided herein is not asked for a means of discrimination nor will it be provided to any parties aside from employees of Ascending Path LLC, and/or medical professionals. The employees of APLLC are not qualified to evaluate medical conditions. This information is for use in the event of an injury or emergency. This application is also intended to assist you in understanding the nature of the activity unto which you will be a participant as well as facilitating our understanding of your preparedness. Please read our Essential Eligibility Criteria for program qualification.

Please select one of the following activities that you will be participating in.*

Trip Date *

Your Mobile # or Alaskan Contact

An Emergency Contact for you (Name & Number):

HEALTH, FITNESS & ESSENTIAL ELIGIBILITY CRITERIA

I am able to effectively communicate with the guides in charge and other participants*
I am able to manage all personal mobility and self-care independently or with the assistance of a companion*
I am able to independently identify and recognize environmental hazards and I am able and willing to understand and recall hazards and risks previously explained by guides and facilitators*
I am able to walk without distress for:*
I'm afraid of heights
I understand that I am required to be able to hold my breath while underwater and while in the water wearing a lifejacket, I am able to independently turn from a face down to a face up position keeping my head above water. (Required YES to participate in the Spencer Glacier Hike, Glacier Kayaking, Ultimate Overnight Trip, and Ice Climbing trip.)*

Please list all sports/fitness activities you regularly engage in
Have you had any health problems, sickness, injuries, hospitalization or surgeries in the last 2 years?*
Please click any of the below drug maintenance categories that you are currently taking: *
None
Anti-coagulants
Anti-seizure Meds
Heart Meds
Epinephrine
Respiratory Meds
Inhalers
Insulin
Do you have any history of back or knee problems, heart or breathing conditions, allergies, seizures, anaphylaxis, asthma, diabetes, or any other conditions relevant to your enjoyment of the activity? (explain below)*
Any other drug categories not listed? (explain below)*
Do you have any other medical or physical condition that might affect your ability to fully participate in the climb, paddle, hike or trip you have registered for without being a danger to yourself or others? (explain below)*
Would you like any special mobility accommodations? (explain below)*

Please explain any health problems, sickness, injuries, hospitalization, medication you are currently taking, or surgeries you have had in the last 2 years or any above "yes" answers (LEAVE BLANK if you answered No)

[initial] All the above is true to the best of my knowledge. *
First Participants Signature*
Second Participants Name

First Name*

Last Name*
Second Participants Date of Birth*
Second Participants Information

Please note that any and all information provided herein is not asked for a means of discrimination nor will it be provided to any parties aside from employees of Ascending Path LLC, and/or medical professionals. The employees of APLLC are not qualified to evaluate medical conditions. This information is for use in the event of an injury or emergency. This application is also intended to assist you in understanding the nature of the activity unto which you will be a participant as well as facilitating our understanding of your preparedness. Please read our Essential Eligibility Criteria for program qualification.

Please select one of the following activities that you will be participating in.*

Trip Date *

Your Mobile # or Alaskan Contact

An Emergency Contact for you (Name & Number):

HEALTH, FITNESS & ESSENTIAL ELIGIBILITY CRITERIA

I am able to effectively communicate with the guides in charge and other participants*
I am able to manage all personal mobility and self-care independently or with the assistance of a companion*
I am able to independently identify and recognize environmental hazards and I am able and willing to understand and recall hazards and risks previously explained by guides and facilitators*
I am able to walk without distress for:*
I'm afraid of heights
I understand that I am required to be able to hold my breath while underwater and while in the water wearing a lifejacket, I am able to independently turn from a face down to a face up position keeping my head above water. (Required YES to participate in the Spencer Glacier Hike, Glacier Kayaking, Ultimate Overnight Trip, and Ice Climbing trip.)*

Please list all sports/fitness activities you regularly engage in
Have you had any health problems, sickness, injuries, hospitalization or surgeries in the last 2 years?*
Please click any of the below drug maintenance categories that you are currently taking: *
None
Anti-coagulants
Anti-seizure Meds
Heart Meds
Epinephrine
Respiratory Meds
Inhalers
Insulin
Do you have any history of back or knee problems, heart or breathing conditions, allergies, seizures, anaphylaxis, asthma, diabetes, or any other conditions relevant to your enjoyment of the activity? (explain below)*
Any other drug categories not listed? (explain below)*
Do you have any other medical or physical condition that might affect your ability to fully participate in the climb, paddle, hike or trip you have registered for without being a danger to yourself or others? (explain below)*
Would you like any special mobility accommodations? (explain below)*

Please explain any health problems, sickness, injuries, hospitalization, medication you are currently taking, or surgeries you have had in the last 2 years or any above "yes" answers (LEAVE BLANK if you answered No)

[initial] All the above is true to the best of my knowledge. *
Third Participants Name

First Name*

Last Name*
Third Participants Date of Birth*
Third Participants Information

Please note that any and all information provided herein is not asked for a means of discrimination nor will it be provided to any parties aside from employees of Ascending Path LLC, and/or medical professionals. The employees of APLLC are not qualified to evaluate medical conditions. This information is for use in the event of an injury or emergency. This application is also intended to assist you in understanding the nature of the activity unto which you will be a participant as well as facilitating our understanding of your preparedness. Please read our Essential Eligibility Criteria for program qualification.

Please select one of the following activities that you will be participating in.*

Trip Date *

Your Mobile # or Alaskan Contact

An Emergency Contact for you (Name & Number):

HEALTH, FITNESS & ESSENTIAL ELIGIBILITY CRITERIA

I am able to effectively communicate with the guides in charge and other participants*
I am able to manage all personal mobility and self-care independently or with the assistance of a companion*
I am able to independently identify and recognize environmental hazards and I am able and willing to understand and recall hazards and risks previously explained by guides and facilitators*
I am able to walk without distress for:*
I'm afraid of heights
I understand that I am required to be able to hold my breath while underwater and while in the water wearing a lifejacket, I am able to independently turn from a face down to a face up position keeping my head above water. (Required YES to participate in the Spencer Glacier Hike, Glacier Kayaking, Ultimate Overnight Trip, and Ice Climbing trip.)*

Please list all sports/fitness activities you regularly engage in
Have you had any health problems, sickness, injuries, hospitalization or surgeries in the last 2 years?*
Please click any of the below drug maintenance categories that you are currently taking: *
None
Anti-coagulants
Anti-seizure Meds
Heart Meds
Epinephrine
Respiratory Meds
Inhalers
Insulin
Do you have any history of back or knee problems, heart or breathing conditions, allergies, seizures, anaphylaxis, asthma, diabetes, or any other conditions relevant to your enjoyment of the activity? (explain below)*
Any other drug categories not listed? (explain below)*
Do you have any other medical or physical condition that might affect your ability to fully participate in the climb, paddle, hike or trip you have registered for without being a danger to yourself or others? (explain below)*
Would you like any special mobility accommodations? (explain below)*

Please explain any health problems, sickness, injuries, hospitalization, medication you are currently taking, or surgeries you have had in the last 2 years or any above "yes" answers (LEAVE BLANK if you answered No)

[initial] All the above is true to the best of my knowledge. *
Fourth Participants Name

First Name*

Last Name*
Fourth Participants Date of Birth*
Fourth Participants Information

Please note that any and all information provided herein is not asked for a means of discrimination nor will it be provided to any parties aside from employees of Ascending Path LLC, and/or medical professionals. The employees of APLLC are not qualified to evaluate medical conditions. This information is for use in the event of an injury or emergency. This application is also intended to assist you in understanding the nature of the activity unto which you will be a participant as well as facilitating our understanding of your preparedness. Please read our Essential Eligibility Criteria for program qualification.

Please select one of the following activities that you will be participating in.*

Trip Date *

Your Mobile # or Alaskan Contact

An Emergency Contact for you (Name & Number):

HEALTH, FITNESS & ESSENTIAL ELIGIBILITY CRITERIA

I am able to effectively communicate with the guides in charge and other participants*
I am able to manage all personal mobility and self-care independently or with the assistance of a companion*
I am able to independently identify and recognize environmental hazards and I am able and willing to understand and recall hazards and risks previously explained by guides and facilitators*
I am able to walk without distress for:*
I'm afraid of heights
I understand that I am required to be able to hold my breath while underwater and while in the water wearing a lifejacket, I am able to independently turn from a face down to a face up position keeping my head above water. (Required YES to participate in the Spencer Glacier Hike, Glacier Kayaking, Ultimate Overnight Trip, and Ice Climbing trip.)*

Please list all sports/fitness activities you regularly engage in
Have you had any health problems, sickness, injuries, hospitalization or surgeries in the last 2 years?*
Please click any of the below drug maintenance categories that you are currently taking: *
None
Anti-coagulants
Anti-seizure Meds
Heart Meds
Epinephrine
Respiratory Meds
Inhalers
Insulin
Do you have any history of back or knee problems, heart or breathing conditions, allergies, seizures, anaphylaxis, asthma, diabetes, or any other conditions relevant to your enjoyment of the activity? (explain below)*
Any other drug categories not listed? (explain below)*
Do you have any other medical or physical condition that might affect your ability to fully participate in the climb, paddle, hike or trip you have registered for without being a danger to yourself or others? (explain below)*
Would you like any special mobility accommodations? (explain below)*

Please explain any health problems, sickness, injuries, hospitalization, medication you are currently taking, or surgeries you have had in the last 2 years or any above "yes" answers (LEAVE BLANK if you answered No)

[initial] All the above is true to the best of my knowledge. *
Fifth Participants Name

First Name*

Last Name*
Fifth Participants Date of Birth*
Fifth Participants Information

Please note that any and all information provided herein is not asked for a means of discrimination nor will it be provided to any parties aside from employees of Ascending Path LLC, and/or medical professionals. The employees of APLLC are not qualified to evaluate medical conditions. This information is for use in the event of an injury or emergency. This application is also intended to assist you in understanding the nature of the activity unto which you will be a participant as well as facilitating our understanding of your preparedness. Please read our Essential Eligibility Criteria for program qualification.

Please select one of the following activities that you will be participating in.*

Trip Date *

Your Mobile # or Alaskan Contact

An Emergency Contact for you (Name & Number):

HEALTH, FITNESS & ESSENTIAL ELIGIBILITY CRITERIA

I am able to effectively communicate with the guides in charge and other participants*
I am able to manage all personal mobility and self-care independently or with the assistance of a companion*
I am able to independently identify and recognize environmental hazards and I am able and willing to understand and recall hazards and risks previously explained by guides and facilitators*
I am able to walk without distress for:*
I'm afraid of heights
I understand that I am required to be able to hold my breath while underwater and while in the water wearing a lifejacket, I am able to independently turn from a face down to a face up position keeping my head above water. (Required YES to participate in the Spencer Glacier Hike, Glacier Kayaking, Ultimate Overnight Trip, and Ice Climbing trip.)*

Please list all sports/fitness activities you regularly engage in
Have you had any health problems, sickness, injuries, hospitalization or surgeries in the last 2 years?*
Please click any of the below drug maintenance categories that you are currently taking: *
None
Anti-coagulants
Anti-seizure Meds
Heart Meds
Epinephrine
Respiratory Meds
Inhalers
Insulin
Do you have any history of back or knee problems, heart or breathing conditions, allergies, seizures, anaphylaxis, asthma, diabetes, or any other conditions relevant to your enjoyment of the activity? (explain below)*
Any other drug categories not listed? (explain below)*
Do you have any other medical or physical condition that might affect your ability to fully participate in the climb, paddle, hike or trip you have registered for without being a danger to yourself or others? (explain below)*
Would you like any special mobility accommodations? (explain below)*

Please explain any health problems, sickness, injuries, hospitalization, medication you are currently taking, or surgeries you have had in the last 2 years or any above "yes" answers (LEAVE BLANK if you answered No)

[initial] All the above is true to the best of my knowledge. *
Sixth Participants Name

First Name*

Last Name*
Sixth Participants Date of Birth*
Sixth Participants Information

Please note that any and all information provided herein is not asked for a means of discrimination nor will it be provided to any parties aside from employees of Ascending Path LLC, and/or medical professionals. The employees of APLLC are not qualified to evaluate medical conditions. This information is for use in the event of an injury or emergency. This application is also intended to assist you in understanding the nature of the activity unto which you will be a participant as well as facilitating our understanding of your preparedness. Please read our Essential Eligibility Criteria for program qualification.

Please select one of the following activities that you will be participating in.*

Trip Date *

Your Mobile # or Alaskan Contact

An Emergency Contact for you (Name & Number):

HEALTH, FITNESS & ESSENTIAL ELIGIBILITY CRITERIA

I am able to effectively communicate with the guides in charge and other participants*
I am able to manage all personal mobility and self-care independently or with the assistance of a companion*
I am able to independently identify and recognize environmental hazards and I am able and willing to understand and recall hazards and risks previously explained by guides and facilitators*
I am able to walk without distress for:*
I'm afraid of heights
I understand that I am required to be able to hold my breath while underwater and while in the water wearing a lifejacket, I am able to independently turn from a face down to a face up position keeping my head above water. (Required YES to participate in the Spencer Glacier Hike, Glacier Kayaking, Ultimate Overnight Trip, and Ice Climbing trip.)*

Please list all sports/fitness activities you regularly engage in
Have you had any health problems, sickness, injuries, hospitalization or surgeries in the last 2 years?*
Please click any of the below drug maintenance categories that you are currently taking: *
None
Anti-coagulants
Anti-seizure Meds
Heart Meds
Epinephrine
Respiratory Meds
Inhalers
Insulin
Do you have any history of back or knee problems, heart or breathing conditions, allergies, seizures, anaphylaxis, asthma, diabetes, or any other conditions relevant to your enjoyment of the activity? (explain below)*
Any other drug categories not listed? (explain below)*
Do you have any other medical or physical condition that might affect your ability to fully participate in the climb, paddle, hike or trip you have registered for without being a danger to yourself or others? (explain below)*
Would you like any special mobility accommodations? (explain below)*

Please explain any health problems, sickness, injuries, hospitalization, medication you are currently taking, or surgeries you have had in the last 2 years or any above "yes" answers (LEAVE BLANK if you answered No)

[initial] All the above is true to the best of my knowledge. *
Seventh Participants Name

First Name*

Last Name*
Seventh Participants Date of Birth*
Seventh Participants Information

Please note that any and all information provided herein is not asked for a means of discrimination nor will it be provided to any parties aside from employees of Ascending Path LLC, and/or medical professionals. The employees of APLLC are not qualified to evaluate medical conditions. This information is for use in the event of an injury or emergency. This application is also intended to assist you in understanding the nature of the activity unto which you will be a participant as well as facilitating our understanding of your preparedness. Please read our Essential Eligibility Criteria for program qualification.

Please select one of the following activities that you will be participating in.*

Trip Date *

Your Mobile # or Alaskan Contact

An Emergency Contact for you (Name & Number):

HEALTH, FITNESS & ESSENTIAL ELIGIBILITY CRITERIA

I am able to effectively communicate with the guides in charge and other participants*
I am able to manage all personal mobility and self-care independently or with the assistance of a companion*
I am able to independently identify and recognize environmental hazards and I am able and willing to understand and recall hazards and risks previously explained by guides and facilitators*
I am able to walk without distress for:*
I'm afraid of heights
I understand that I am required to be able to hold my breath while underwater and while in the water wearing a lifejacket, I am able to independently turn from a face down to a face up position keeping my head above water. (Required YES to participate in the Spencer Glacier Hike, Glacier Kayaking, Ultimate Overnight Trip, and Ice Climbing trip.)*

Please list all sports/fitness activities you regularly engage in
Have you had any health problems, sickness, injuries, hospitalization or surgeries in the last 2 years?*
Please click any of the below drug maintenance categories that you are currently taking: *
None
Anti-coagulants
Anti-seizure Meds
Heart Meds
Epinephrine
Respiratory Meds
Inhalers
Insulin
Do you have any history of back or knee problems, heart or breathing conditions, allergies, seizures, anaphylaxis, asthma, diabetes, or any other conditions relevant to your enjoyment of the activity? (explain below)*
Any other drug categories not listed? (explain below)*
Do you have any other medical or physical condition that might affect your ability to fully participate in the climb, paddle, hike or trip you have registered for without being a danger to yourself or others? (explain below)*
Would you like any special mobility accommodations? (explain below)*

Please explain any health problems, sickness, injuries, hospitalization, medication you are currently taking, or surgeries you have had in the last 2 years or any above "yes" answers (LEAVE BLANK if you answered No)

[initial] All the above is true to the best of my knowledge. *
Eighth Participants Name

First Name*

Last Name*
Eighth Participants Date of Birth*
Eighth Participants Information

Please note that any and all information provided herein is not asked for a means of discrimination nor will it be provided to any parties aside from employees of Ascending Path LLC, and/or medical professionals. The employees of APLLC are not qualified to evaluate medical conditions. This information is for use in the event of an injury or emergency. This application is also intended to assist you in understanding the nature of the activity unto which you will be a participant as well as facilitating our understanding of your preparedness. Please read our Essential Eligibility Criteria for program qualification.

Please select one of the following activities that you will be participating in.*

Trip Date *

Your Mobile # or Alaskan Contact

An Emergency Contact for you (Name & Number):

HEALTH, FITNESS & ESSENTIAL ELIGIBILITY CRITERIA

I am able to effectively communicate with the guides in charge and other participants*
I am able to manage all personal mobility and self-care independently or with the assistance of a companion*
I am able to independently identify and recognize environmental hazards and I am able and willing to understand and recall hazards and risks previously explained by guides and facilitators*
I am able to walk without distress for:*
I'm afraid of heights
I understand that I am required to be able to hold my breath while underwater and while in the water wearing a lifejacket, I am able to independently turn from a face down to a face up position keeping my head above water. (Required YES to participate in the Spencer Glacier Hike, Glacier Kayaking, Ultimate Overnight Trip, and Ice Climbing trip.)*

Please list all sports/fitness activities you regularly engage in
Have you had any health problems, sickness, injuries, hospitalization or surgeries in the last 2 years?*
Please click any of the below drug maintenance categories that you are currently taking: *
None
Anti-coagulants
Anti-seizure Meds
Heart Meds
Epinephrine
Respiratory Meds
Inhalers
Insulin
Do you have any history of back or knee problems, heart or breathing conditions, allergies, seizures, anaphylaxis, asthma, diabetes, or any other conditions relevant to your enjoyment of the activity? (explain below)*
Any other drug categories not listed? (explain below)*
Do you have any other medical or physical condition that might affect your ability to fully participate in the climb, paddle, hike or trip you have registered for without being a danger to yourself or others? (explain below)*
Would you like any special mobility accommodations? (explain below)*

Please explain any health problems, sickness, injuries, hospitalization, medication you are currently taking, or surgeries you have had in the last 2 years or any above "yes" answers (LEAVE BLANK if you answered No)

[initial] All the above is true to the best of my knowledge. *
Ninth Participants Name

First Name*

Last Name*
Ninth Participants Date of Birth*
Ninth Participants Information

Please note that any and all information provided herein is not asked for a means of discrimination nor will it be provided to any parties aside from employees of Ascending Path LLC, and/or medical professionals. The employees of APLLC are not qualified to evaluate medical conditions. This information is for use in the event of an injury or emergency. This application is also intended to assist you in understanding the nature of the activity unto which you will be a participant as well as facilitating our understanding of your preparedness. Please read our Essential Eligibility Criteria for program qualification.

Please select one of the following activities that you will be participating in.*

Trip Date *

Your Mobile # or Alaskan Contact

An Emergency Contact for you (Name & Number):

HEALTH, FITNESS & ESSENTIAL ELIGIBILITY CRITERIA

I am able to effectively communicate with the guides in charge and other participants*
I am able to manage all personal mobility and self-care independently or with the assistance of a companion*
I am able to independently identify and recognize environmental hazards and I am able and willing to understand and recall hazards and risks previously explained by guides and facilitators*
I am able to walk without distress for:*
I'm afraid of heights
I understand that I am required to be able to hold my breath while underwater and while in the water wearing a lifejacket, I am able to independently turn from a face down to a face up position keeping my head above water. (Required YES to participate in the Spencer Glacier Hike, Glacier Kayaking, Ultimate Overnight Trip, and Ice Climbing trip.)*

Please list all sports/fitness activities you regularly engage in
Have you had any health problems, sickness, injuries, hospitalization or surgeries in the last 2 years?*
Please click any of the below drug maintenance categories that you are currently taking: *
None
Anti-coagulants
Anti-seizure Meds
Heart Meds
Epinephrine
Respiratory Meds
Inhalers
Insulin
Do you have any history of back or knee problems, heart or breathing conditions, allergies, seizures, anaphylaxis, asthma, diabetes, or any other conditions relevant to your enjoyment of the activity? (explain below)*
Any other drug categories not listed? (explain below)*
Do you have any other medical or physical condition that might affect your ability to fully participate in the climb, paddle, hike or trip you have registered for without being a danger to yourself or others? (explain below)*
Would you like any special mobility accommodations? (explain below)*

Please explain any health problems, sickness, injuries, hospitalization, medication you are currently taking, or surgeries you have had in the last 2 years or any above "yes" answers (LEAVE BLANK if you answered No)

[initial] All the above is true to the best of my knowledge. *
Tenth Participants Name

First Name*

Last Name*
Tenth Participants Date of Birth*
Tenth Participants Information

Please note that any and all information provided herein is not asked for a means of discrimination nor will it be provided to any parties aside from employees of Ascending Path LLC, and/or medical professionals. The employees of APLLC are not qualified to evaluate medical conditions. This information is for use in the event of an injury or emergency. This application is also intended to assist you in understanding the nature of the activity unto which you will be a participant as well as facilitating our understanding of your preparedness. Please read our Essential Eligibility Criteria for program qualification.

Please select one of the following activities that you will be participating in.*

Trip Date *

Your Mobile # or Alaskan Contact

An Emergency Contact for you (Name & Number):

HEALTH, FITNESS & ESSENTIAL ELIGIBILITY CRITERIA

I am able to effectively communicate with the guides in charge and other participants*
I am able to manage all personal mobility and self-care independently or with the assistance of a companion*
I am able to independently identify and recognize environmental hazards and I am able and willing to understand and recall hazards and risks previously explained by guides and facilitators*
I am able to walk without distress for:*
I'm afraid of heights
I understand that I am required to be able to hold my breath while underwater and while in the water wearing a lifejacket, I am able to independently turn from a face down to a face up position keeping my head above water. (Required YES to participate in the Spencer Glacier Hike, Glacier Kayaking, Ultimate Overnight Trip, and Ice Climbing trip.)*

Please list all sports/fitness activities you regularly engage in
Have you had any health problems, sickness, injuries, hospitalization or surgeries in the last 2 years?*
Please click any of the below drug maintenance categories that you are currently taking: *
None
Anti-coagulants
Anti-seizure Meds
Heart Meds
Epinephrine
Respiratory Meds
Inhalers
Insulin
Do you have any history of back or knee problems, heart or breathing conditions, allergies, seizures, anaphylaxis, asthma, diabetes, or any other conditions relevant to your enjoyment of the activity? (explain below)*
Any other drug categories not listed? (explain below)*
Do you have any other medical or physical condition that might affect your ability to fully participate in the climb, paddle, hike or trip you have registered for without being a danger to yourself or others? (explain below)*
Would you like any special mobility accommodations? (explain below)*

Please explain any health problems, sickness, injuries, hospitalization, medication you are currently taking, or surgeries you have had in the last 2 years or any above "yes" answers (LEAVE BLANK if you answered No)

[initial] All the above is true to the best of my knowledge. *
Participants 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*
IF PARENT OR GUARDIAN OF A MINOR: I, as a parent or guardian of the below named minor, have discussed the nature of the activity, hazards, risks, and potential outcome with my child or ward and hereby give my permission for my child or ward to participate in the trip and further agree, individually and on behalf on my child or ward, to the terms of the above.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Please note that any and all information provided herein is not asked for a means of discrimination nor will it be provided to any parties aside from employees of Ascending Path LLC, and/or medical professionals. The employees of APLLC are not qualified to evaluate medical conditions. This information is for use in the event of an injury or emergency. This application is also intended to assist you in understanding the nature of the activity unto which you will be a participant as well as facilitating our understanding of your preparedness. Please read our Essential Eligibility Criteria for program qualification.

Please select one of the following activities that you will be participating in.*

Trip Date *

Your Mobile # or Alaskan Contact

An Emergency Contact for you (Name & Number):

HEALTH, FITNESS & ESSENTIAL ELIGIBILITY CRITERIA

I am able to effectively communicate with the guides in charge and other participants*
I am able to manage all personal mobility and self-care independently or with the assistance of a companion*
I am able to independently identify and recognize environmental hazards and I am able and willing to understand and recall hazards and risks previously explained by guides and facilitators*
I am able to walk without distress for:*
I'm afraid of heights
I understand that I am required to be able to hold my breath while underwater and while in the water wearing a lifejacket, I am able to independently turn from a face down to a face up position keeping my head above water. (Required YES to participate in the Spencer Glacier Hike, Glacier Kayaking, Ultimate Overnight Trip, and Ice Climbing trip.)*

Please list all sports/fitness activities you regularly engage in
Have you had any health problems, sickness, injuries, hospitalization or surgeries in the last 2 years?*
Please click any of the below drug maintenance categories that you are currently taking: *
None
Anti-coagulants
Anti-seizure Meds
Heart Meds
Epinephrine
Respiratory Meds
Inhalers
Insulin
Do you have any history of back or knee problems, heart or breathing conditions, allergies, seizures, anaphylaxis, asthma, diabetes, or any other conditions relevant to your enjoyment of the activity? (explain below)*
Any other drug categories not listed? (explain below)*
Do you have any other medical or physical condition that might affect your ability to fully participate in the climb, paddle, hike or trip you have registered for without being a danger to yourself or others? (explain below)*
Would you like any special mobility accommodations? (explain below)*

Please explain any health problems, sickness, injuries, hospitalization, medication you are currently taking, or surgeries you have had in the last 2 years or any above "yes" answers (LEAVE BLANK if you answered No)

[initial] All the above is true to the best of my knowledge. *
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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