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Peak Mountain Guides

PARTICIPANT RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT
***READ BEFORE SIGNING***
 

Peak Mountain Guides, LLC provides the following information and warnings to all prospective participants in activities guided by Peak Mountain Guides, LLC:

1.         Outdoor physical activities such as rock climbing, via ferrata, climbing, skiing, and ice climbing are inherently dangerous sports and these outdoor activities carry inherent risks, regardless of the care taken by participants.  These risks include, but are not limited to, weather related incidents such as extreme cold temperatures, extreme hot temperatures, wind, snow, rain, sleet, hail, and lightning; equipment failure or malfunction; negligence of yourself and/or other participants; attacks by or encounters with insects, reptiles, and other animals, including rattlesnakes, bears, and mountain lions; and altitude sickness.  Risks include injuries from falling, jumping, or otherwise abruptly leaving a rock or ice climbing path, whether unintentionally, intentionally, or through negligence, as well as injuries from rockfalls, rockslides, avalanches, disturbance or movement of rocks, dirt, trees, or other natural terrain elements which may fall onto a climber or skier or fall away in a manner than leaves the climber or skier with no foothold, handhold, or ground beneath them.  Resulting injuries may include, but are not limited to, fatigue, chills, dizziness, hypothermia, heat stroke, dehydration, injuries resulting from your body hitting water, from being hit by rocks or boulders, from avalanches, bites, claw marks or other injuries from animal and reptile attacks; broken bones, head injury, paralysis and death.  These injuries can include PERMANENT INJURY, PARALYSIS, DISABILITY, or DEATH.

2.         Peak Mountain Guides, LLC, its employees, management and agents do not, and cannot, guarantee your safety, although following the protocols and instructions provided during the activities may lessen your risk.

3.         In consideration of being allowed to participate in the activities provided by Peak Mountain Guides, LLC, the undersigned agrees to:

             KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, including those risks and resulting injuries arising from the negligence of the participant, or others, and by signature below, does assume full responsibility for participation.

            WEAR NECESSARY SAFETY EQUIPMENT provided, and the undersigned recognizes that failure to do so increases the potential for severe injury or death. 

            COMPLY WITH ALL INSTRUCTIONS provided by the guides leading the activity.   If participant notices or observes any unusual or significant hazard during participation, participant will immediately stop and/or remove him/herself from participation and immediately notify the guides or staff leading the activity of the hazardous condition.

4.         The undersigned agrees and acknowledges that it may become necessary for Peak Mountain Guides, the guide(s) leading the activity, or other staff to refuse or terminate my participation in the activity if I am judged to be incapable of meeting the rigors and requirements of the activity.  The undersigned agrees to accept such judgment and agrees not to engage in activities that are beyond my capabilities, and not to cause any third party or other participant to be endangered by my actions during the activity.

The undersigned warrants and represents to Peak Mountain Guides, LLC, their employees, staff, agents and management that I am in good health and have no physical or mental limitations or conditions that would affect my safe participation in the activity, or the safety of other participants in the activity, and have not been otherwise advised by a qualified medial professional.

The undersigned further represents that I am not infectious with any contagious disease, including, but not limited to, COVID-19, nor am I aware of any exposure to COVID-19 in the past fourteen (14) days. The undersigned understands and acknowledges that while Peak Mountain Guides, LLC, and its staff, employees, agents and management are taking reasonable precautions, are following local guidelines for preventing the transmission of disease, in particular COVID-19, they cannot guarantee that there will be no exposure to the disease during the activity I am participating in.  

By participating in or attending any activity directed by Peak Mountain Guides, LLC, regardless of location, I consent to the use of any photographs, pictures, film or videotape taken of me or provided by me for publicity, promotions, television, websites, or any other use, and expressly waive any right of privacy, compensation, copyright, or other ownership right connected to the same.

AND, I, the undersigned, for myself and on behalf of my heirs, agents, personal representatives, next of kin, or legal representative, HEREBY RELEASE, WAIVE, INDEMNIFY AND HOLD HARMLESS Peak Mountain Guides, LLC, its officers, officials, agents, employees, other participants, sponsors, advertisers, and the owners/lessors of any premises in or on which the activities are conducted (“Releasees”), from any and all claims, demands, losses, and liability arising out of or related to any ILLNESS, INJURY, DISABILITY OR DEATH I may suffer, or loss to my person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES or otherwise, to the fullest extent permitted by law.

I AFFIRM THAT I HAVE FULLY READ THIS DOCUMENT and fully understand its terms, understand that I have given up substantial rights by signing it and signing it freely and voluntarily without inducement.

Today's Date: January 20, 2022

 

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*
Third Participant's Name

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
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*
Medical Disclosure
Medical History *
Allergies
Heart Disease
Bleeding Disorders
Diabetes
Respiratory Illness
Neurological Disorders
High Altitude Illness
Orthopedic Problems
None

Provide detail of any history above.

Medications you are currently taking.

Describe any physical limitations we should be aware of.
FOR PARENTS/GUARDIANS OF PARTICIPANT OF MINOR AGE (UNDER AGE 18 AT TIME OF REGISTRATION) This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liability incidents due to my minor child's involvement or participation in these Programs as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by law.
Parent or Guardian's Name

First Name*

Middle 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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