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Please fill out this information when booking a trip or guided event through Basecamp. All information will be kept confidential but is necessary so that we can plan your backcountry adventure. Thank you!

By filling out this information on this form you are entering an Agreement between you, (the "Participant"), and The Ski Shop, LLC, doing business as Laramie's Basecamp (the "Company") wherein the Company will provider certain agreed upon services to Participant in exchange for a fee. You are acknowledging that this Agreement affects your legal rights.

The Participant certifies that they are fully capable of participating in all activities associated with the Company's services. Participant realizes that many of Company's services will take Participant to areas where medical care is limited. Participant is solely responsible for managing Participant's medical conditions. Participant agrees to provide information to Company about Participant's medical conditions for which Participant may require assitance while participating in Company's services. All such information will be kept confidential by Company and use only for the purpose of providing care to Participant.

The Participant will defend, indemnify and hold harmless the Company from and against all claims and causes of action of any kind, including those sounding in tort or in contract, or based upon any law or statute, which are in any way related to, arise from, or otherwise are premised upon the User’s use of, the Company's services. Without limiting the foregoing, the Participant hereby also agrees the Participant assumes all risks associated with using the Company's services, and releases the Company for any claim of negligence related to or based upon the Company's services, or its production or supply, or related to arising from the User’s use of the Company's services. This indemnity, assumption of the risk, and release includes any claims related to minor children in the Participant's care.

This Agreement shall be interpreted under the laws of the State of Wyoming.

Participant has carefully read, clearly understood and accepted the terms and conditions stated herein and acknowledges that this Agreement shall be effective and binding upon Participant and Participant's heirs, assigns, personal representative and estate and for all members of Participant's family, including minor children.

 

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*
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*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Health & Safety

Birthdate

Please list any allergies food &/ or environmental and how you treat allergic reactions (ie I carry Benadryl in my pack, I have an EpiPen on me at all times, etc)

Please list any dietary restrictions (gluten-free, vegetarian, vegan, dairy-free, etc)

Please list any medical conditions that may require treatment on this trip. Common conditions are allergies, asthma, diabetes, previous altitude sickness, heart conditions etc.
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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