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VISITOR’S ACKNOWLEDGEMENT OF RISKS AND REGISTRATION

Please fill out one form for each participant, with parent or guardian signature for participating minors.

In consideration of the services provided by Exum Mountain Guide Service and School of Mountaineering, Inc., their officers, agents, employees, and stockholders, and all other persons or entities associated with those businesses (hereinafter collectively referred to as “Exum”), I agree as follows:

Although Exum has taken reasonable steps to provide me with appropriate equipment and skilled guides so I can enjoy an activity for which I may not be skilled, Exum has informed me that this activity is not without risk. Certain risks are inherent in each activity and cannot be eliminated without destroying the unique character of this activity. These inherent risks are some of the same elements that contribute to the unique character of the 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. Exum 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 these inherent risks. The following describes some, BUT NOT ALL, of these risks:

Rockfall; Icefall; Avalanches; Electrical storms; Mountain storms; Snow; Ice; Rain; Hail; Sleet; Lightning; Falling; Objects falling from above; Unstable or loose rock, snow, ice, talus, moraine, scree, boulders, and/or other terrain; Slippery terrain; Falling and injury while skiing or snowshoeing; Extreme cold and hot temperatures; Water crossings by foot or boat; Wildlife encounters; Dehydration; High altitude and altitude sickness; Wind; Failure of mountaineering equipment despite reasonable care and use; Injury from mountaineering equipment despite reasonable care and use; Careless or reckless behavior on the part of other members of the group despite reasonable supervision; Guide error; Careless or reckless behavior on the part of third parties; Limited possibility of assistance/rescue; and Limited ability/inability to communicate with rescue personnel.

I am aware that this activity entails risks of injury or death to any participant. I understand the description of these inherent risks is not complete and that the other unknown or unanticipated risks 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 full knowledge of the inherent risks.

I acknowledge that engaging in this activity may require a degree of skill and knowledge different from other activities. I acknowledge that I have responsibilities as a participant. 

I acknowledge that the staff of Exum has been available to explain more fully to me the nature and physical demands of this activity and inherent risks, hazards, and dangers associated with this activity.

I certify that I am fully capable of participating in this activity.

I ASSUME AND ACCEPT FULL RESPONSIBILITY FOR MYSELF FOR BODILY INJURY, DEATH, OR LOSS OF PERSONAL PROPERTY AND EXPENSE 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 MY NEGLIGENCE IN PARTICIPATING IN THIS ACTIVITY.

I ASSUME AND ACCEPT FULL RESPONSIBILITY FOR ALL MINOR CHILDREN IN MY CARE, CUSTODY AND CONTROL FOR BODILY INJURY, DEATH, OR LOSS OF PERSONAL PROPERTY AND EXPENSE 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 SUCH MINOR CHILDREN’S NEGLIGENCE IN PARTICIPATING IN THIS ACTIVITY.

By signing below I am certifying that I have carefully read, clearly understand, and accept ALL the terms and conditions stated herein and acknowledge that this agreement shall be effective and binding upon myself, my heirs, assigns, personal representative and estate, and for all members of my family, including minor children.

The employees of Exum Mountain Guides are not qualified to evaluate medical conditions. The information disclosed in this agreement is very important in the event of an injury or emergency. If you have any questions regarding your participation in any activities we strongly suggest that you obtain your doctor's approval. 

I understand that: 1) the use of alcohol or drugs is prohibited before and during all activities, 2) possession of firearms is prohibited during any activity or in any Exum building, and 3) participation in this activity grants Exum Mountain Guides permission to use any photographs and/or videos of me, or my minor children, for marketing purposes. 

I further understand that Exum Mountain Guides provides recreational climbing and skiing activities and instruction suitable only for climbing or skiing with our guides. Participation in any Exum activity does NOT qualify participant(s) to climb or ski without a guide.

 

Please select who will be participating...
AdultMinor
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First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First 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*
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Reservation Information

My reservation is under the last name... *

Date of my first activity with Exum *
Personal Equipment
I am choosing to use my own equipment*
No
Yes

If yes, specify equipment.
Medical Information

Medical Insurance Company *
Does the participant have any physical or medical conditions or allergies that could affect their ability to fully participate in the climbing or skiing activity in which they are enrolled?*
No
Yes

If yes, specify conditions or allergies.
Is the participant taking any medication for the above conditions?*
No
Yes

If yes, specify medications.

Anything else your guide should be aware of?
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*

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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