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Chugach Adventures’ Participant Release of Liability


 

Participant Release of Liability, Waiver of Claims, Assumption of Risks and Indemnity

In consideration of the services of Chugach Adventures, L.L.C., the State of Alaska, the United States Forest Service and their various agents, owners, officers, volunteers, parent or subsidiary corporations, participants, employees, subcontractors, sales agents, sponsors and all other persons or entities acting in any capacity on their behalf (hereinafter collectively referred to as “C.A.”), I hereby agree to release and discharge C.A. on behalf of myself, my parents, my heirs, assigns, personal representative and estate as follows:

1. Inherent Risks I acknowledge that any form of adventure activity or trip (such as rafting, canoeing, kayaking, SUP, hiking, glacier walking, and flight seeing) entails known and unanticipated risks that could result in physical or emotional injury, death, or damage to myself, to property, or to third parties. I understand and acknowledge that the enjoyment and excitement of adventure activities is derived in part from inherent risks incurred by activity beyond the accepted safety of life at home or in my normal day to day activities and that these inherent risks contribute to my enjoyment and excitement and are an integral reason for my participation in this activity. I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activity. I also understand and acknowledge that failing to use, or properly use safety type equipment increases my risk of injury or of not surviving an accident or incident while participating in an adventure activity. The inherent risks associated with the water related (rafting, canoeing, kayaking) trip in which I am about to participate include, but are not limited to: encountering whitewater rapids and changing water flows and the possibility that I will be jolted, jarred, bounced, thrown to and fro and shaken about during rides through some of these rapids or changing water flows; it is possible that I could be injured if I come in contact with food boxes, oars/paddles, other storage containers, or other fixed equipment necessary to the operation or outfitting of the watercraft; there may be errors in food storage or preparations; I recognize there are foot cups or foot holds in watercraft which may assist in stabilizing or holding myself or others in the watercraft (raft, canoe, or kayak) but which may present an increased risk of knee, ankle or other injury as a result of restricted movement; the watercraft may break down or be faulty; it is possible that loss of control of the watercraft could occur resulting in collision or capsizing or sinking and that if a watercraft turns over or flips I could be "washed" overboard; watercrafts are slippery when wet and are naturally unstable so that I could slip and fall or be knocked out of the watercraft even in flat or non-moving water; while in the water I may become disoriented, panicked and/or experience trauma from rocks, boulders, icebergs, etc.; I can slip or fall during hiking or portaging or getting to and from the watercraft and I understand that the areas in which I might hike sometimes hide dangerous obstacles such as tree wells, tree stumps, creeks, rocks and boulders, forest dead fall, slick gravel, mud, and ice, etc.; the watercraft may collide with or encounter other watercrafts, man-made or natural objects including submerged or semi-submerged trees, rocks, branches, boulders, bridges, icebergs, submerged glacier etc.; accidents can occur getting on and off the watercrafts; changing weather conditions, storms or even lightening are possible; exposure to the natural elements can be uncomfortable and/or harmful and I am aware that this exposure could cause sunburn, dehydration, heat exhaustion, heat stroke, heat cramps or fatigue, some or all of which may diminish my or the other participants’ ability to react or respond; I understand that prolonged exposure to cold water can result in “cold water immersion” syndrome or “cold shock,” hypothermia and in extreme cases death; I may encounter dangerous wildlife, insects, etc.; communication in the river terrain in which this activity occurs is always difficult and in the event of an accident, rescue and medical treatment may not be immediately available.

I acknowledge that hiking activities (including hikes, treks, glacier walks, etc.) entail known, unknown and unanticipated risks that could result in physical or emotional injury, death, or damage to myself, to property or to third parties. I acknowledge that the inherent risks associated with these activities includes but is not limited to the following: I can slip or fall during hiking, climbing or getting to and from the activity areas; I understand that the areas in which I might hike or walk include beautiful mountain, valley and meadow terrain; the natural beauty of these areas sometimes hide dangerous obstacles which present additional inherent risks. Those obstacles or risks include, but are not limited to: roots, branches and other debris on the trails, tree wells, tree stumps, creeks, rocks and boulders, forest deadfall, slick gravel and ice, holes and depressions, submerged objects in flooded or wet areas, thin ice and deep water and varying and difficult conditions. I acknowledge that it is my sole responsibility to observe and make myself familiar with the areas in which hiking activities occur. Participants may become lost or separated from their companions in forested areas, wild and rugged terrain, or bad weather. I acknowledge that I may encounter hazards such as: loose, falling, rolling and breaking rock; unstable or loose rock, talus and/or scree slopes, boulders; snow, rock and ice, or massive loosening and movement of dirt and rock. I acknowledge that food preparation is an integral part of some of these activities and that I and other participants may be eating in the outdoors and in community style environments and that some of the food may not be to my liking; there may be errors in food storage or preparation that could cause my dissatisfaction and/or illness; I acknowledge my responsibility to inform C.A. of any specific food related allergies.

I acknowledge that I may choose to participate in activities that are provided by other vendors or operators (IE – the helicopter transport, or Alaska Railroad transport) over which C.A. has no control. Those activities are incidental to the activities provided by C.A. and may involve errors in judgment by the other vendors or operators for which C.A. can bear no liability. C.A. is not a “Common Carrier” but rather is in the business of providing adventure type trips. Transportation to and from the activity is incidental to the activity. Transport and car, bus or van travel in some instances may be provided by C.A. and may involve errors in judgment by C.A. staff operating the vans, buses, cars or other type transport vehicles. The vehicles and transport trailers may malfunction, break down or be poorly maintained, causing injury, accidents, delays or in the extreme case, death.

By signing this Release of Liability, Waiver of Claims, Assumption of Risks and Indemnity Agreement, I acknowledge that I AM ULTIMATELY RESPONSIBLE for my own safety during my participation in this activity.

Furthermore, C.A. Guides have difficult jobs to perform. They seek safety, but they are not infallible. They might be ignorant of a participant’s fitness or abilities. They might misjudge the weather, the elements, or the terrain. They may give inadequate warnings or instructions, and/or I as the participant may fail to understand the safety directions due to language issues. The equipment being used might malfunction. Further, I may encounter: the negligence or mis-behaviors of other visitors or participants who may be present, participants giving or following inappropriate advice, mine or others’ failure to follow the rules of C.A. and/or my own negligence or inexperience, some or all of which may diminish my or the other participants’ ability to react or respond. I also acknowledge that I have the responsibility to inspect any and all facilities or equipment to be used and to immediately advise C.A. of anything which I consider to be unsafe or to refuse to participate. I specifically acknowledge that decisions made by guides/staff and participants are often made in wilderness/remote/dangerous settings and are often made based on imprecise, momentary and subjective perceptions so that decisions are subject to errors in judgment that cannot and should not be associated with fault at a later point in time.

2. Express Assumption of Risk I expressly agree and promise to accept and assume (take home to myself) all the risks existing in this activity. My participation in this activity is purely voluntary, and I elect to participate in spite of the risks. I expressly agree and acknowledge that the terms and conditions of this Release of Liability, Waiver of Claims, Assumption of Risks and Indemnity Agreement are contractual in nature and that I am signing it of my own free will.

3. Release and Waiver of Rights Including for Claims of NEGLIGENCE I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless C.A. from any and all claims, demands, or causes of action, which are in any way connected with my participation in this activity or my use of C.A.’s equipment or facilities, including any such Claims which allege negligent acts or omissions of C.A.

4. Indemnity Should C.A. or anyone acting on their behalf, be required to incur attorney’s fees and costs to enforce this agreement or defend against lawsuits or claims brought by me, I agree to indemnify and hold them harmless (in other words, I agree to pay for...) for all such fees and costs.

5. Personal Skill & Insurance I certify that I have sufficient skill and fitness to participate in the activities offered by C.A. I further certify that I have no medical, mental or physical conditions which could interfere with my safety or ability to participate in these activities, or else I am willing to assume and bear the cost of all risks that may be created, directly or indirectly, by any such condition. I further certify that I have adequate insurance to cover any injury, damage or emergency transportation costs I may cause or suffer while participating, or else agree to bear the costs of such injury, damage or emergency transportation costs myself.

6. Medical Issues I further agree that, in the event that C.A. deems it necessary to administer emergency first aid or CPR or to remove me from its activities or premises or from the field or to seek emergency medical care for me that, by signing this document, I am giving C.A. permission to: administer emergency first aid or CPR, secure emergency transport or medical care and/or disclose any medical information it may have about me to any health care provider which may become involved in my care, treatment or removal from the field. By signing this document I am waiving any right to object to or bring any type of action or claim against C.A. for its administration of emergency first aid or CPR or for securing emergency transport or medical care and/or for the disclosure of personal medical information it may have about me to any health related person who becomes involved in my care or removal from C.A. activities or the field.

7. Photographic Assignment I understand that the C.A. reserves the right to take photographic or film (of whatsoever nature) records of any or all of the activities conducted within its premises and I hereby agree that the C.A. may use such records for promotional and/or commercial purposes without any remuneration to me. I hereby assign all right, title and interest I may have in or to any and all media in which my name or likeness might be used by the C.A. I agree and acknowledge that C.A. cannot control media or photographic images of me that may be generated or disseminated by other participants.

8. Release as Contract and Personal Capacity I expressly agree and acknowledge that the terms and conditions of this Release of Liability, Waiver of Claims, Assumption of Risks and Indemnity Agreement are contractual in nature and that I am signing it of my own free will. I expressly acknowledge that I am not under the influence of drugs or alcohol at the time of my signing of this document and that there are no other impediments or reasons why I would lack the capacity to enter into this contract with C.A.

9. Forum Selection, Severability, Breach of Contract/Warranty Waiver, Etc. In the event I file a lawsuit against C.A., I agree to do so solely in the Third Judicial District of the State of Alaska, and I further agree that the substantive law of Alaska shall apply in that action without regard to the conflict of law rules of that state. I hereby irrevocably waive any other jurisdiction or venue to which I or my estate might otherwise have been entitled. I agree to submit to the jurisdiction of the Alaska courts. I agree that if any portion of this agreement/contract is found to be void or unenforceable, the remaining portion shall remain in full force and effect; this document is intended to be interpreted as broadly as possible. A copy of this release contract can be used as if it was the original. I understand that this document constitutes the entire Agreement/Contract between myself and C.A. and that it cannot be modified or changed in any way by representations or statements of any nature (be they vocal, advertising, etc.) outside of this document; in other words, I am also waiving any claims I might have for breach of contract or warranty for statements or representations made outside of this release contract.

Today's Date: September 23, 2019

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Health, Fitness, & Wellness Information

Please note that any & all information provided herein is not asked for a means of discrimination nor will it be provided to any parties aside from employees of Chugach Adventures LLC, and/or medical professionals.  The employees of Chugach Adventures LLC are not qualified to evaluate medical conditions.  This information is for use in the event of an injury or illness.  This information will also facilitate our understanding of your preparedness.  Additionally, please relay any pertinent information herein directly to your guide(s) on the day of your adventure.



Date of Tour *
Activity you are participating in*
Camping
Glacier Kayaking
Heli Hiking Adventure
Glacier Salmon Bake
Heli Raft or Heli Kayak
Rafting

Weight *

Height *
Any mobility issues?*
No
Yes

If you answered "Yes" to the above question please explain
Any sickness, injuries or surgeries that you have had in the last 12 months that we should be aware of?*
No
Yes

If you answered "Yes" to the question above, please let us know the specifics.

Do you have any food allergies, or any other severe allergies?

Please list any medications you are taking.
Do you have any history of back or knee problems, heart or breathing conditions, seizures, anaphylaxsis, asthma, diabetes, or any other condition relevant to your adventure activity.*
No
Yes

If you answered "Yes" to the question above, please let us know the specifics.
What best describes your activity level?*
Walker, Less than 2 Miles.
Day Hiker- Easily Hike 1-2 hours
Backpacker- Can Easily Hike with a Backpack for Greater than 3 Hours.
Runner- Greater than 1 Hour
Marathon- Extreme Sports

Please list any and all pertinent sports or activities you engage in?
Do you need any other special accommodations?*
No
Yes
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Health, Fitness, & Wellness Information

Please note that any & all information provided herein is not asked for a means of discrimination nor will it be provided to any parties aside from employees of Chugach Adventures LLC, and/or medical professionals.  The employees of Chugach Adventures LLC are not qualified to evaluate medical conditions.  This information is for use in the event of an injury or illness.  This information will also facilitate our understanding of your preparedness.  Additionally, please relay any pertinent information herein directly to your guide(s) on the day of your adventure.



Date of Tour *
Activity you are participating in*
Camping
Glacier Kayaking
Heli Hiking Adventure
Glacier Salmon Bake
Heli Raft or Heli Kayak
Rafting

Weight *

Height *
Any mobility issues?*
No
Yes

If you answered "Yes" to the above question please explain
Any sickness, injuries or surgeries that you have had in the last 12 months that we should be aware of?*
No
Yes

If you answered "Yes" to the question above, please let us know the specifics.

Do you have any food allergies, or any other severe allergies?

Please list any medications you are taking.
Do you have any history of back or knee problems, heart or breathing conditions, seizures, anaphylaxsis, asthma, diabetes, or any other condition relevant to your adventure activity.*
No
Yes

If you answered "Yes" to the question above, please let us know the specifics.
What best describes your activity level?*
Walker, Less than 2 Miles.
Day Hiker- Easily Hike 1-2 hours
Backpacker- Can Easily Hike with a Backpack for Greater than 3 Hours.
Runner- Greater than 1 Hour
Marathon- Extreme Sports

Please list any and all pertinent sports or activities you engage in?
Do you need any other special accommodations?*
No
Yes
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Health, Fitness, & Wellness Information

Please note that any & all information provided herein is not asked for a means of discrimination nor will it be provided to any parties aside from employees of Chugach Adventures LLC, and/or medical professionals.  The employees of Chugach Adventures LLC are not qualified to evaluate medical conditions.  This information is for use in the event of an injury or illness.  This information will also facilitate our understanding of your preparedness.  Additionally, please relay any pertinent information herein directly to your guide(s) on the day of your adventure.



Date of Tour *
Activity you are participating in*
Camping
Glacier Kayaking
Heli Hiking Adventure
Glacier Salmon Bake
Heli Raft or Heli Kayak
Rafting

Weight *

Height *
Any mobility issues?*
No
Yes

If you answered "Yes" to the above question please explain
Any sickness, injuries or surgeries that you have had in the last 12 months that we should be aware of?*
No
Yes

If you answered "Yes" to the question above, please let us know the specifics.

Do you have any food allergies, or any other severe allergies?

Please list any medications you are taking.
Do you have any history of back or knee problems, heart or breathing conditions, seizures, anaphylaxsis, asthma, diabetes, or any other condition relevant to your adventure activity.*
No
Yes

If you answered "Yes" to the question above, please let us know the specifics.
What best describes your activity level?*
Walker, Less than 2 Miles.
Day Hiker- Easily Hike 1-2 hours
Backpacker- Can Easily Hike with a Backpack for Greater than 3 Hours.
Runner- Greater than 1 Hour
Marathon- Extreme Sports

Please list any and all pertinent sports or activities you engage in?
Do you need any other special accommodations?*
No
Yes
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Health, Fitness, & Wellness Information

Please note that any & all information provided herein is not asked for a means of discrimination nor will it be provided to any parties aside from employees of Chugach Adventures LLC, and/or medical professionals.  The employees of Chugach Adventures LLC are not qualified to evaluate medical conditions.  This information is for use in the event of an injury or illness.  This information will also facilitate our understanding of your preparedness.  Additionally, please relay any pertinent information herein directly to your guide(s) on the day of your adventure.



Date of Tour *
Activity you are participating in*
Camping
Glacier Kayaking
Heli Hiking Adventure
Glacier Salmon Bake
Heli Raft or Heli Kayak
Rafting

Weight *

Height *
Any mobility issues?*
No
Yes

If you answered "Yes" to the above question please explain
Any sickness, injuries or surgeries that you have had in the last 12 months that we should be aware of?*
No
Yes

If you answered "Yes" to the question above, please let us know the specifics.

Do you have any food allergies, or any other severe allergies?

Please list any medications you are taking.
Do you have any history of back or knee problems, heart or breathing conditions, seizures, anaphylaxsis, asthma, diabetes, or any other condition relevant to your adventure activity.*
No
Yes

If you answered "Yes" to the question above, please let us know the specifics.
What best describes your activity level?*
Walker, Less than 2 Miles.
Day Hiker- Easily Hike 1-2 hours
Backpacker- Can Easily Hike with a Backpack for Greater than 3 Hours.
Runner- Greater than 1 Hour
Marathon- Extreme Sports

Please list any and all pertinent sports or activities you engage in?
Do you need any other special accommodations?*
No
Yes
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Health, Fitness, & Wellness Information

Please note that any & all information provided herein is not asked for a means of discrimination nor will it be provided to any parties aside from employees of Chugach Adventures LLC, and/or medical professionals.  The employees of Chugach Adventures LLC are not qualified to evaluate medical conditions.  This information is for use in the event of an injury or illness.  This information will also facilitate our understanding of your preparedness.  Additionally, please relay any pertinent information herein directly to your guide(s) on the day of your adventure.



Date of Tour *
Activity you are participating in*
Camping
Glacier Kayaking
Heli Hiking Adventure
Glacier Salmon Bake
Heli Raft or Heli Kayak
Rafting

Weight *

Height *
Any mobility issues?*
No
Yes

If you answered "Yes" to the above question please explain
Any sickness, injuries or surgeries that you have had in the last 12 months that we should be aware of?*
No
Yes

If you answered "Yes" to the question above, please let us know the specifics.

Do you have any food allergies, or any other severe allergies?

Please list any medications you are taking.
Do you have any history of back or knee problems, heart or breathing conditions, seizures, anaphylaxsis, asthma, diabetes, or any other condition relevant to your adventure activity.*
No
Yes

If you answered "Yes" to the question above, please let us know the specifics.
What best describes your activity level?*
Walker, Less than 2 Miles.
Day Hiker- Easily Hike 1-2 hours
Backpacker- Can Easily Hike with a Backpack for Greater than 3 Hours.
Runner- Greater than 1 Hour
Marathon- Extreme Sports

Please list any and all pertinent sports or activities you engage in?
Do you need any other special accommodations?*
No
Yes
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Health, Fitness, & Wellness Information

Please note that any & all information provided herein is not asked for a means of discrimination nor will it be provided to any parties aside from employees of Chugach Adventures LLC, and/or medical professionals.  The employees of Chugach Adventures LLC are not qualified to evaluate medical conditions.  This information is for use in the event of an injury or illness.  This information will also facilitate our understanding of your preparedness.  Additionally, please relay any pertinent information herein directly to your guide(s) on the day of your adventure.



Date of Tour *
Activity you are participating in*
Camping
Glacier Kayaking
Heli Hiking Adventure
Glacier Salmon Bake
Heli Raft or Heli Kayak
Rafting

Weight *

Height *
Any mobility issues?*
No
Yes

If you answered "Yes" to the above question please explain
Any sickness, injuries or surgeries that you have had in the last 12 months that we should be aware of?*
No
Yes

If you answered "Yes" to the question above, please let us know the specifics.

Do you have any food allergies, or any other severe allergies?

Please list any medications you are taking.
Do you have any history of back or knee problems, heart or breathing conditions, seizures, anaphylaxsis, asthma, diabetes, or any other condition relevant to your adventure activity.*
No
Yes

If you answered "Yes" to the question above, please let us know the specifics.
What best describes your activity level?*
Walker, Less than 2 Miles.
Day Hiker- Easily Hike 1-2 hours
Backpacker- Can Easily Hike with a Backpack for Greater than 3 Hours.
Runner- Greater than 1 Hour
Marathon- Extreme Sports

Please list any and all pertinent sports or activities you engage in?
Do you need any other special accommodations?*
No
Yes
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Health, Fitness, & Wellness Information

Please note that any & all information provided herein is not asked for a means of discrimination nor will it be provided to any parties aside from employees of Chugach Adventures LLC, and/or medical professionals.  The employees of Chugach Adventures LLC are not qualified to evaluate medical conditions.  This information is for use in the event of an injury or illness.  This information will also facilitate our understanding of your preparedness.  Additionally, please relay any pertinent information herein directly to your guide(s) on the day of your adventure.



Date of Tour *
Activity you are participating in*
Camping
Glacier Kayaking
Heli Hiking Adventure
Glacier Salmon Bake
Heli Raft or Heli Kayak
Rafting

Weight *

Height *
Any mobility issues?*
No
Yes

If you answered "Yes" to the above question please explain
Any sickness, injuries or surgeries that you have had in the last 12 months that we should be aware of?*
No
Yes

If you answered "Yes" to the question above, please let us know the specifics.

Do you have any food allergies, or any other severe allergies?

Please list any medications you are taking.
Do you have any history of back or knee problems, heart or breathing conditions, seizures, anaphylaxsis, asthma, diabetes, or any other condition relevant to your adventure activity.*
No
Yes

If you answered "Yes" to the question above, please let us know the specifics.
What best describes your activity level?*
Walker, Less than 2 Miles.
Day Hiker- Easily Hike 1-2 hours
Backpacker- Can Easily Hike with a Backpack for Greater than 3 Hours.
Runner- Greater than 1 Hour
Marathon- Extreme Sports

Please list any and all pertinent sports or activities you engage in?
Do you need any other special accommodations?*
No
Yes
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Health, Fitness, & Wellness Information

Please note that any & all information provided herein is not asked for a means of discrimination nor will it be provided to any parties aside from employees of Chugach Adventures LLC, and/or medical professionals.  The employees of Chugach Adventures LLC are not qualified to evaluate medical conditions.  This information is for use in the event of an injury or illness.  This information will also facilitate our understanding of your preparedness.  Additionally, please relay any pertinent information herein directly to your guide(s) on the day of your adventure.



Date of Tour *
Activity you are participating in*
Camping
Glacier Kayaking
Heli Hiking Adventure
Glacier Salmon Bake
Heli Raft or Heli Kayak
Rafting

Weight *

Height *
Any mobility issues?*
No
Yes

If you answered "Yes" to the above question please explain
Any sickness, injuries or surgeries that you have had in the last 12 months that we should be aware of?*
No
Yes

If you answered "Yes" to the question above, please let us know the specifics.

Do you have any food allergies, or any other severe allergies?

Please list any medications you are taking.
Do you have any history of back or knee problems, heart or breathing conditions, seizures, anaphylaxsis, asthma, diabetes, or any other condition relevant to your adventure activity.*
No
Yes

If you answered "Yes" to the question above, please let us know the specifics.
What best describes your activity level?*
Walker, Less than 2 Miles.
Day Hiker- Easily Hike 1-2 hours
Backpacker- Can Easily Hike with a Backpack for Greater than 3 Hours.
Runner- Greater than 1 Hour
Marathon- Extreme Sports

Please list any and all pertinent sports or activities you engage in?
Do you need any other special accommodations?*
No
Yes
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Health, Fitness, & Wellness Information

Please note that any & all information provided herein is not asked for a means of discrimination nor will it be provided to any parties aside from employees of Chugach Adventures LLC, and/or medical professionals.  The employees of Chugach Adventures LLC are not qualified to evaluate medical conditions.  This information is for use in the event of an injury or illness.  This information will also facilitate our understanding of your preparedness.  Additionally, please relay any pertinent information herein directly to your guide(s) on the day of your adventure.



Date of Tour *
Activity you are participating in*
Camping
Glacier Kayaking
Heli Hiking Adventure
Glacier Salmon Bake
Heli Raft or Heli Kayak
Rafting

Weight *

Height *
Any mobility issues?*
No
Yes

If you answered "Yes" to the above question please explain
Any sickness, injuries or surgeries that you have had in the last 12 months that we should be aware of?*
No
Yes

If you answered "Yes" to the question above, please let us know the specifics.

Do you have any food allergies, or any other severe allergies?

Please list any medications you are taking.
Do you have any history of back or knee problems, heart or breathing conditions, seizures, anaphylaxsis, asthma, diabetes, or any other condition relevant to your adventure activity.*
No
Yes

If you answered "Yes" to the question above, please let us know the specifics.
What best describes your activity level?*
Walker, Less than 2 Miles.
Day Hiker- Easily Hike 1-2 hours
Backpacker- Can Easily Hike with a Backpack for Greater than 3 Hours.
Runner- Greater than 1 Hour
Marathon- Extreme Sports

Please list any and all pertinent sports or activities you engage in?
Do you need any other special accommodations?*
No
Yes
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Health, Fitness, & Wellness Information

Please note that any & all information provided herein is not asked for a means of discrimination nor will it be provided to any parties aside from employees of Chugach Adventures LLC, and/or medical professionals.  The employees of Chugach Adventures LLC are not qualified to evaluate medical conditions.  This information is for use in the event of an injury or illness.  This information will also facilitate our understanding of your preparedness.  Additionally, please relay any pertinent information herein directly to your guide(s) on the day of your adventure.



Date of Tour *
Activity you are participating in*
Camping
Glacier Kayaking
Heli Hiking Adventure
Glacier Salmon Bake
Heli Raft or Heli Kayak
Rafting

Weight *

Height *
Any mobility issues?*
No
Yes

If you answered "Yes" to the above question please explain
Any sickness, injuries or surgeries that you have had in the last 12 months that we should be aware of?*
No
Yes

If you answered "Yes" to the question above, please let us know the specifics.

Do you have any food allergies, or any other severe allergies?

Please list any medications you are taking.
Do you have any history of back or knee problems, heart or breathing conditions, seizures, anaphylaxsis, asthma, diabetes, or any other condition relevant to your adventure activity.*
No
Yes

If you answered "Yes" to the question above, please let us know the specifics.
What best describes your activity level?*
Walker, Less than 2 Miles.
Day Hiker- Easily Hike 1-2 hours
Backpacker- Can Easily Hike with a Backpack for Greater than 3 Hours.
Runner- Greater than 1 Hour
Marathon- Extreme Sports

Please list any and all pertinent sports or activities you engage in?
Do you need any other special accommodations?*
No
Yes
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
Check to receive information, news, and discounts by e-mail.
A signed copy of this waiver will be sent to the email address you provide.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
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 Health, Fitness, & Wellness Information

Please note that any & all information provided herein is not asked for a means of discrimination nor will it be provided to any parties aside from employees of Chugach Adventures LLC, and/or medical professionals.  The employees of Chugach Adventures LLC are not qualified to evaluate medical conditions.  This information is for use in the event of an injury or illness.  This information will also facilitate our understanding of your preparedness.  Additionally, please relay any pertinent information herein directly to your guide(s) on the day of your adventure.



Date of Tour *
Activity you are participating in*
Camping
Glacier Kayaking
Heli Hiking Adventure
Glacier Salmon Bake
Heli Raft or Heli Kayak
Rafting

Weight *

Height *
Any mobility issues?*
No
Yes

If you answered "Yes" to the above question please explain
Any sickness, injuries or surgeries that you have had in the last 12 months that we should be aware of?*
No
Yes

If you answered "Yes" to the question above, please let us know the specifics.

Do you have any food allergies, or any other severe allergies?

Please list any medications you are taking.
Do you have any history of back or knee problems, heart or breathing conditions, seizures, anaphylaxsis, asthma, diabetes, or any other condition relevant to your adventure activity.*
No
Yes

If you answered "Yes" to the question above, please let us know the specifics.
What best describes your activity level?*
Walker, Less than 2 Miles.
Day Hiker- Easily Hike 1-2 hours
Backpacker- Can Easily Hike with a Backpack for Greater than 3 Hours.
Runner- Greater than 1 Hour
Marathon- Extreme Sports

Please list any and all pertinent sports or activities you engage in?
Do you need any other special accommodations?*
No
Yes
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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