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Registration &Waiver

PART I: ASSUMPTION OF RISK & WAIVER OF CLAIMS

In agreeing to participate in an Adaptive Expeditions program, event, course or trip, I acknowledge, understand and appreciate the fact that sports, fitness, adventure, and outdoor recreation activities such as rock climbing, slacklining, paddlesports, archery, ropes & challenge courses, zip lines, races, running, cycling, swimming, surfing, hiking, skateboarding, fitness and exertion activities, horseback riding, travel to and from program sites,and all other such outdoor recreation activities entail risks that include but are not limited to loss or damage of personal property, injury or fatality due to trauma from impacts with other people, animals or objects, falling from heights, drowning, asphyxiation, allergic reactions to foods or insects, exposure to temperature extremes or inclement weather, sunburn, equipment failure, inadequate training, inadequate personal conditioning, staff mistakes and bad judgment, vehicle accidents while traveling to and from the activity site, negligence by any party, or other similar causes. I further recognize that remote locations can delay the delivery of emergency medical services.

I have also made my own investigation of the risks associated with this program, event, course or trip, I understand these risks, and I assume them knowingly and willingly. I further understand that I can ask any leader of the program, event, course or trip for more information about the risks of the activity, and I can decline to participate at any time.

I hereby agree to hold Adaptive Expeditions, its agents, staff and other program participants harmless from any and all liability, action, claims, and damage of every kind whether caused either by negligence or risks inherent in the activity.

PART II: AUTHORIZATION FOR EMERGENCY MEDICAL CARE

In the event I am rendered unable to communicate by emergency or accident, I authorize, request and agree to accept financial responsibility for such medical and surgical services as may be necessary.

PART III: MEDICAL INFORMATION

Through physician consultation, I am aware of my general physical condition and affirm that I am fit to participate in this program. I have informed Adaptive Expeditions about all medical concerns that might affect my ability to participate as well as all information I'd like Adaptive Expeditions to pass on to EMS or hospital staff in case of emergency. I have fully disclosed in writing all relevant medical information. I understand that anyone with severe allergies to food, plants or insects, must bring and be able to self-administer their own medication.

PART IV: Essental Eligabiltiy Critiera (EEC)

In addition to acknowledging general fitness to participate in this program, all participants must acknowledge the ability to perform the following minimal functional thresholds for safe participation:

  • Wear properly fit protective equipment, such as cycling helmets and lifejackets, wherever and whenever required by outdoor recreation industry standards
  • Independently hold head upright without neck / head support
  • Breathe independently (i.e., not require medical devices to sustain breathing)
  • Manage personal care independently or with assistance of a companion
  • Manage personal mobility independently or with a reasonable amount of assistance. A reasonable amount of assistance is determined in part by environmental factors and the safety of participants, instructors and staff. Reasonable assistance will not fundamentally alter the nature of the program.
  • Follow instructions and effectively communicate independently or with assistance of a companion

All water-based programparticipants (including all paddlesports programs) must additionally acknowledge the ability to perform the following:

  • Independently maintain sealed airway passages while under water

Paddlesports program participants must also acknowledge the ability to perform the following in the water:

  • Independently turn from face-down to face-up and remain floating face up while wearing a properly fitted life jacket
  • Get in / out of a paddlecraft independently or with a reasonable amount of assistance
  • Independently wet-exit (i.e., get out and from under a capsized paddlecraft)
  • Reenter the paddlecraft following deep water capsize independently or with a reasonable amount of assistance
  • Maintain a safe body position while attempting skills and activities listed in the appropriate course description, and have the ability to recognize and identify to others when such efforts would be unsafe given your personal situation

Note: Instructors may include additional safety-based EEC given environmental conditions where a specific course is being held. For example, programming in cold water venues may include the additional EEC that participants acknowledge that they can tolerate X degree water for X period of time.

By signing this document I thereby acknowledge both general fitness to participate as well asthe ability to perform the minimal functional thresholds for safe participation (EEC) for the program for which I am registering. Further, I acknowledge my ability and willingness to alert Adaptive Expeditions staff if at any point in time I reassess my general fitness to participate or my ability to perform these minimal functional thresholds for safe participation.

PART IV: MEDIA RELEASE

I grant permission to the Adaptive Expeditionsto use photographs, motion pictures, recordings, or any other record of this event for any legitimate purpose.

 

 

First Participant's Name

First Name*

Last Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
Subscribe to Adaptive Expeditions' Monthly Newsletter
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Adaptive Expeditions Programs
For which event or program are you registering? **Note that this registration program opened in a new window or tab. The Adaptive Expeditions event page is also still open on your computer. You can toggle between tabs to see the name and date of the program for which you are registering.*

Date of the program for which you are registering: *
Do you have a physical disability?*
No
Yes
Do you have a sensory disability (visual or auditory impairment or loss)?*
No
Yes
With the help of just one average strength person can you transfer yourself to the floor and back again?*
No
Yes
Maybe?
Do you have a history of pressure sores?*
No
Yes
Have you attended one of our aquatic safety sessions, paddlesport pool sessions, or an Adaptive Paddling Workshop in the past?*
No
Yes
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.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First 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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