Loading...

NORTH FORK ADVENTURES, LLC  RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT (“AGREEMENT”)

 

     In consideration of my receipt of the services provided by North Fork Adventures, LLC their owners, officers, agents, employees, and all other persons or entities acting in any capacity on its behalf (the “Company”) and my participation in a guided tour, backpacking, caving, rock climbing, canoeing, team building or other outdoor adventure activities offered through the Company (the “Activities”), the undersigned person or persons (“Participant”) represents that Participant is an adult at least eighteen (18) years of age or a minor who is accompanied by a competent adult, and Participant understands that rock climbing, backpacking, caving, and other outdoor adventure activities may entail strenuous physical exercise that requires sufficient physical stamina and conditioning.  Participant represents and warrants that they are in good health and proper physical condition to engage in rock climbing, backpacking, caving, and other outdoor adventure activities.  Participant understands that individuals who have physical impairments or serious medical conditions should not engage in rock climbing, backpacking, caving, canoeing, team building, or other outdoor adventure activities.  Participant understands that they should not engage in activities that could be detrimental to their health or which would be opposed by their doctor because of recent illness, injury, or surgery.  Participant acknowledges and agrees that they have adequate insurance to cover any injury or damage they may cause or suffer while participating in the Activities, or else agrees to bear the cost of such injury or damage to themselves or others.  

     Participant understands and acknowledges that they have been fully informed of the inherent hazards and risks associated with the Activities, transportation of equipment related to such Activities, and the travelling to and from Activities sites.  Inherent hazards and risks include but are not limited to:

  1. Risk of injury from participation in the Activities or from the equipment used in rock climbing, backpacking, caving, canoeing, team building, and other outdoor adventure activities in which risks are significant and include the potential for permanent disability and death.
     
  2. Possible equipment failure and/or malfunction of Participant’s own or other’s equipment.
     
  3. Participant’s own negligence and/or the negligence of others, including employees, agents, independent contractors or representatives of the Company, including but not limited to operator or guide error.
     
  4. Injury to hands, fingers, feet and toes, including but not limited to inflammation and/or strain of muscles ligaments and/or tendons, nerve damage or compression, and broken bones.
     
  5. Injuries from falling may occur from exposure to high altitude, which may affect judgment and coordination, or injuries may occur from Participant not paying close attention to his or her own climbing or others climbing with or near Participant.
     
  6. Broken bones, severe injuries to the head, neck, and back which may result in severe physical impairment or even death.
     
  7. Cold weather and heat related injuries and illness including but not limited to frostnip, frost bite, heat exhaustion, heat stroke, sunburn, hypothermia and dehydration.
     
  8. Exposure to outdoor elements, including but not limited to avalanche, rock fall, inclement weather, thunder and lightning, severe and or varied wind, temperature or weather conditions.
     
  9. Attack by or encounter with insects, reptiles, birds and/or other animals.  
     
  10. Accidents or illness occurring in remote places where there are no available medical facilities.
     
  11. Fatigue, chill, and/or dizziness, which may diminish Participant’s reaction time and increase risk of accident.
     
  12. Participant’s sense of balance, physical coordination, and ability to follow instructions.
     
  13. The hazards of walking on uneven terrain and slip and falls.
     
  14. Being struck by rock fall or other objects dislodged or thrown from above.

     Participant understands that the risks which are enumerated above are not a complete list of risks inherent in the Activities which Participant is about to engage.  Participant understands that additional, unknown or unanticipated risks, which are not readily foreseeable but that may arise during the Activities, may result in injury, illness, or death.  PARTICIPANT EXPRESSLY AGREES TO ACCEPT AND ASSUME ALL SUCH RISKS (INCLUDING BUT NOT LIMITED TO THE RISKS DESCRIBED HEREIN) AND ALL RESPONSIBILITY FOR ANY INJURIES (WHETHER TO PERSON OR PROPERTY), LOSSES, COSTS, AND DAMAGES PARTICIPANT INCURS IN CONNECTION WITH OR ARISING FROM PARTICIPATION IN THE ACTIVITIES.  THE UNDERSIGNED REPRESENTS THAT PARTICIPATION IN THE ACTIVITIES IS PURELY VOLUNTARY, AND THAT THEY ELECT TO PARTICIPATE IN THE ACTIVITIES IN SPITE OF THE RISKS.  

     BY SIGNING BELOW, PARTICIPANT RELEASES, DISCHARGES AND COVENANTS NOT TO BRING ANY LAWSUIT OR CLAIM AGAINST THE COMPANY, ITS AFFILIATES, SUCCESSORS, OR ASSIGNS AND, IF APPLICABLE, OWNERS AND LESSORS OF THE PREMISES OR GROUNDS ON WHICH THE ACTIVITIES OCCUR (EACH ONE OF THEM IS CONSIDERED “RELEASEES”).

     PARTICIPANT AGREES TO HOLD HARMLESS AND INDEMNIFY RELEASEES FROM ALL LIABILITY, CLAIMS, OR DEMANDS FOR INJURIES, LOSSES, OR DEATH CAUSED OR ALLEGED TO BE CAUSED TO PERSON OR PROPERTY, IN WHOLE OR IN PART, IN ANY WAY BY THE PARTICIPANT’S PARTICIPATION IN THE ACTIVITIES OR THE NEGLIGENCE OF RELEASEES.

     IF A PARENT, GUARDIAN, OR OTHER ADULT INDIVIDUAL IS SIGNING THIS WAIVER ON BEHALF OF A MINOR, SUCH PARENT, GUARDIAN, OR OTHER ADULT AGREES TO INDEMNIFY THE RELEASEES FROM ALL LIABILITY, CLAIMS, OR DEMANDS FOR INJURIES, LOSSES, OR DEATH SUFFERED BY THE MINOR PARTICIPANT WHICH ARE CAUSED OR ALLEGED TO BE CAUSED BY THE ACTIVITIES OR THE RELEASEES.  PARTICIPANT AGREES FURTHER TO INDEMNIFY COMPANY FROM ANY ATTORNEYS FEES AND LEGAL COSTS INCURRED TO ENFORCE THIS WAIVER OR FOR ANY LEGAL CLAIM ARISING OUT OF OR RELATED TO THE UNDERSIGNED’S OR THE MINOR’S PARTICIPATION IN THE ACTIVITIES.

     Participant has read this Agreement and has signed it freely and willingly, without inducement or assurance of any nature, and intends this Agreement to be a complete and unconditional release of all liability to the greatest extent allowed by law and agrees further that, if any portion of this Agreement is held to be invalid, the balance shall continue in full force and effect.  

    As used herein, the term “Undersigned” refers to the Participant.

    By signing this Agreement, Participant intends to be legally bound by the terms herein.


Dated: January 26, 2021

 

 

First Participant's Name

First Name*

Last Name*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Information
Complete if a minor is participating in the Activities:
Parent, Guardian, or Adult should check this box to affirm their understanding that they agree to indemnify the Releasees (including the Company) from any legal claims, demands, or suits brought by or on behalf of the minor participant.
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information
Complete if a minor is participating in the Activities:
Parent, Guardian, or Adult should check this box to affirm their understanding that they agree to indemnify the Releasees (including the Company) from any legal claims, demands, or suits brought by or on behalf of the minor participant.
Second Participant's Signature*
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information
Complete if a minor is participating in the Activities:
Parent, Guardian, or Adult should check this box to affirm their understanding that they agree to indemnify the Releasees (including the Company) from any legal claims, demands, or suits brought by or on behalf of the minor participant.
Third Participant's Signature*
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information
Complete if a minor is participating in the Activities:
Parent, Guardian, or Adult should check this box to affirm their understanding that they agree to indemnify the Releasees (including the Company) from any legal claims, demands, or suits brought by or on behalf of the minor participant.
Fourth Participant's Signature*
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information
Complete if a minor is participating in the Activities:
Parent, Guardian, or Adult should check this box to affirm their understanding that they agree to indemnify the Releasees (including the Company) from any legal claims, demands, or suits brought by or on behalf of the minor participant.
Fifth Participant's Signature*
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information
Complete if a minor is participating in the Activities:
Parent, Guardian, or Adult should check this box to affirm their understanding that they agree to indemnify the Releasees (including the Company) from any legal claims, demands, or suits brought by or on behalf of the minor participant.
Sixth Participant's Signature*
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information
Complete if a minor is participating in the Activities:
Parent, Guardian, or Adult should check this box to affirm their understanding that they agree to indemnify the Releasees (including the Company) from any legal claims, demands, or suits brought by or on behalf of the minor participant.
Seventh Participant's Signature*
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information
Complete if a minor is participating in the Activities:
Parent, Guardian, or Adult should check this box to affirm their understanding that they agree to indemnify the Releasees (including the Company) from any legal claims, demands, or suits brought by or on behalf of the minor participant.
Eighth Participant's Signature*
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information
Complete if a minor is participating in the Activities:
Parent, Guardian, or Adult should check this box to affirm their understanding that they agree to indemnify the Releasees (including the Company) from any legal claims, demands, or suits brought by or on behalf of the minor participant.
Ninth Participant's Signature*
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information
Complete if a minor is participating in the Activities:
Parent, Guardian, or Adult should check this box to affirm their understanding that they agree to indemnify the Releasees (including the Company) from any legal claims, demands, or suits brought by or on behalf of the minor participant.
Tenth Participant's Signature*
Parent or Guardian's Email Address

Email*

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

Our activities can be strenuous and often offer exercise of a different nature than most participants are used to. We do not want you to engage in activities that could be detrimental to your health or which would be opposed by your doctor because of recent illness, injury, or surgery. We ask you for the following information so we can be aware of potential problems and will be better able to help you to safely enjoy the activities here.

Have you ever had: YES NO

Allergies?*
No
Yes

If yes please list:
Diabetes*
No
Yes
Epilepsy*
No
Yes
Asthma*
No
Yes
High Blood Pressure*
No
Yes
Are you pregnant?*
No
Yes
Are you currently under a doctor's care?*
No
Yes

For what Reason?
Are you taking any medication?*
No
Yes

What type?
Are you allergic to insect bites and stings? If so do you carry medication?*
No
Yes
Do you have any condition which might affect your health or the health of others?*
No
Yes

If so please explain:
Are there any limitations on your activities?*
No
Yes

If so please explain:

Any additional information you think we should have?

Thank you for taking the time to fill out this registration. If you have any questions regarding this form or its contents please don't hesitate to ask.

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*

Last Name*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information
Complete if a minor is participating in the Activities:
Parent, Guardian, or Adult should check this box to affirm their understanding that they agree to indemnify the Releasees (including the Company) from any legal claims, demands, or suits brought by or on behalf of the minor participant.
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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!