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Universal Trip/Activity Liability Waiver

Agreement to Participate, Including Assumption of Risks and Agreements of Release and Indemnity

I understand and acknowledge that I have voluntarily agreed to participate in the trip/activity with the knowledge and understanding of the numerous risks and dangers involved, both known and unknown, including, but not limited to: exposure to the natural elements, which may include heat, extreme cold and high altitude, snow, sleet and rain; close personal contact, including the possibility of unwelcome touching, and dependence on other participants and staff; injury from (a) dangerous activities and/or contact with animals, (ii)  carelessness of other participants and staff, or (iii) failure of equipment and/or structures. I also understand that incidents may occur in remote places which may be many hours from medical facilities. These risks and hazards are inherent in the trip/activity; I understand and acknowledge that the above list is not complete or exhaustive and that other hazards and risks, known and unknown, may result in loss or damage to personal property, emotional and other personal injuries, including falls, abrasions, sprains, breaks, permanent disabilities and, in extreme cases, even death.

I represent that I have no medical or emotional condition which may adversely affect my participation in this trip and its associated activities, or which may cause me to be a danger to myself or others. I understand that it is my responsibility, and mine only, to determine my suitability, medical and otherwise, for participation in the trip and its associated activities.

ACKNOWLEDGEMENT AND ASSUMPTION OF ALL RISKS
I acknowledge, and assume all risks of participation in the trip, its activities and the environment in which it is conducted, whether or not these risks are inherent, and whether or not they are described above. I understand that in order to participate in the trip/activity, I must, and I hereby do, give up and irrevocably waive any and all rights I have or may ever have to hold Devil’s Thumb Ranch Operating Company Inc., DTR Horse Operations, LLC, Colorado Mountain Resorts Investors, LLC, Grand County Ranches, LLC, Rams Curl Ranch LLC, Quad Ranches LLC, and any of their owners, agents, employees, officers and directors liable for any injury or damage which I may suffer. I ASSUME THE RISK OF ALL LOSS, DAMAGE, INJURY, OR DEATH suffered which may in any way arise from or be associated with participation in any exercise or activity, or the use of the equipment and facilities of Devil’s Thumb Ranch and DTR Horse Operations, LLC.

Without limiting the foregoing, I specifically acknowledge the risks associated with horseback riding, wagon/sleigh rides, or any stables-related activities as well as the use of property, animals and stables facilities, the unpredictability of animals and the risk of handling firearms and being near others that have firearms in their possession.

Without limiting the foregoing, I specifically acknowledge the risks associated with the Zip Line Challenge Course and that the course includes instruction, and moderate to strong physical exertion on high element challenge courses, including a network of cables, ropes, swings and platforms, as high as 80 feet off the ground, over and on which I may walk, swing, and otherwise move with or without the assistance of other persons.  I understand that I have voluntarily agreed to participate in the Zip Line Challenge Course. 

AGREEMENTS OF RELEASE AND INDEMNITY
I HEREBY WAIVE, RELEASE FROM LIABILITY, AND COVENANT NOT TO SUE DEVIL’S THUMB RANCH OPERATING COMPANY INC., DTR HORSE OPERATIONS, LLC, COLORADO MOUNTAIN RESORTS INVESTORS, LLC, GRAND COUNTY RANCHES, LLC, RAMS CURL RANCH LLC, QUAD RANCHES LLC, OR THEIR OWNERS, AGENTS, EMPLOYEES, MANAGERS, OFFICERS AND DIRECTORS AND AFFILIATES FOR OR WITH RESPECT TO ANY AND ALL LIABILITY RESULTING FROM OR ARISING OUT OF PARTICIPATION IN THE ACTIVITIES OF THE TRIP AND/OR ACTIVITIES DESIGNATED ABOVE.  This waiver, release and covenant not to sue extends to any and all claims, demands, complaints, causes of action, costs or expenses (including attorney's fees), which I may have now or hereafter acquire, known or unknown, contingent or liquidated, of any nature whatsoever, including negligence, arising from or which in the future may arise from, any of the causes noted and/or any act or omission of any individual, whether agent, owner, manager or employee of Devil’s Thumb Ranch Operating Company Inc., DTR Horse Operations LLC, a third party, an independent contractor or another guest at the facility.  This waiver, release from liability and covenant not to sue shall be binding on me, and upon my heirs, personal representatives and all other successors in interest.  It is intended that this waiver, release and covenant not to sue be interpreted as broadly and inclusively in scope as permitted by the laws of the State of Colorado, including C.R.S. 13-22-107.

Any and all disputes, claims, actions, causes of action or controversies of any kind or nature whatsoever arising out of or in connection with the trip or activity designated above including but not limited to any alleged negligence, tort, breach of contract, waiver, intentional conduct, medical care or treatment shall be resolved by arbitration with the American Arbitration Association, in Grand County, Colorado, pursuant to the Commercial Arbitration Rules of the American Arbitration Association.  This agreement to arbitrate shall be specifically enforceable under the laws of the State of Colorado. Any lawsuit to enforce an arbitration shall be instituted solely in the State of Colorado, and this waiver and agreement shall be governed by Colorado law.

I HEREBY ACCEPT FULL LEGAL RESPONSIBILITY and shall defend, hold harmless and indemnify Devil’s Thumb Ranch Operating Company Inc., DTR Horse Operations, LLC, Colorado Mountain Resorts Investors, LLC, Grand County Ranches, LLC, Rams Curl Ranch LLC, Quad Ranches LLC, and their owners, employees, agents, managers, officers and directors and affiliates from any and all liabilities, damages to property or injuries sustained as a result of my participation in the trip/activity designated above.

OTHER
I authorize Devil’s Thumb Ranch Operating Company Inc. to provide or obtain medical care for me in the event of an incident requiring medical attention, and I further authorize Devil’s Thumb Ranch Operating Company Inc. to exchange with any third-party medical care giver such information regarding my medical history or condition as may be deemed important to either of them.

I understand that the trip/activity and all aspects of it are purely voluntary and I may choose not to participate. I agree that I will follow all safety instructions. I further agree to allow Devil’s Thumb Ranch to use photographic or other images of me for marketing or any other purpose deemed reasonable by Devil’s Thumb Ranch.

I have carefully read this form, fully understand its contents, and sign it of my own free will.  I verify that I have fully completed this form and that I have authority to enter into this form agreement. Should any part of this agreement be deemed not enforceable by a Court of competent authority, the remainder of the agreement shall nevertheless remain in full force and effect.


Dated: May 28, 2020

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Information

To properly size equipment for your activity, please provide your height, weight and shoe size in the box provided.

HEALTH STATEMENT 

The proposed activity provided by DTR Horse Operations LLC requires participation in physical exercises which are, by their nature, physically demanding. Many of the activities will challenge you, and cause surges in blood pressure and pulse rates. It is imperative that you are free of any heart or any other diseases. Therefore, all participants must be free of medical or physical conditions which might create undue risks to themselves or any others who depend on them. If there is any doubt about your ability to safely participate in this experience, you should have a physical examination.

HEALTH HISTORY: (Select the appropriate answers and describe any YES answers)

HAVE YOU OR DO YOU CURRENTLY HAVE ANY HEART PROBLEMS?*
No
Yes
DO YOU FREQUENTLY SUFFER FROM PAINS IN YOUR CHEST?*
No
Yes
DO YOU OFTEN FEEL FAINT OR HAVE SPELLS OF SEVERE DIZZINESS?*
No
Yes
HAS YOUR DOCTOR EVER TOLD YOU THAT YOU HAVE HIGH BLOOD PRESSURE?*
No
Yes
ARE YOU A SMOKER?*
No
Yes
DO YOU HAVE ARTHRITIS, JOINT, OR BACK PROBLEMS THAT MAY BE AGGRAVATED BY EXERCISE?*
No
Yes
DO YOU HAVE ASTHMA OR ANY OTHER RESPIRATORY ISSUES?*
No
Yes
HAVE YOU HAD ANY OPERATIONS OR SERIOUS INJURIES?*
No
Yes
ARE THERE ANY ACTIVITIES TO BE LIMITED/DISCOURAGED BY PHYSICIAN'S ADVICE?*
No
Yes
ARE YOU ALLERGIC TO ANY MEDICINES, INSECTS, OR POLLEN?*
No
Yes
DO YOU HAVE EPILEPSY?*
No
Yes
DO YOU HAVE DIABETES?*
No
Yes
(Horseback Riding and Biking ONLY) WILL YOU BE ELECTING TO WEAR A HELMET FOR THIS ACTIVITY*
Yes
No
Brought My Own

(Only Fill out if answered yes to any of the above questions) BRIEFLY EXPLAIN AREAS OF CONCERN

Representation and Emergency Authorization:
This health history is correct so far as I know, and I believe that my health is satisfactory to participate in challenge course activities. In the event I suffer any sickness, accident or injury, Devil's Thumb Ranch Operating Company Inc. and DTR Horse Operations LLC, its employees, and agents, have my express permission to secure such medical treatment as deemed necessary in their sole discretion. I hereby give my consent to Devil's Thumb Ranch Operating Company Inc. and DTR Horse Operations LLC, its employees, and agents to consent to "Medical Care" and "Dental Care" for me. "Medical Care" means X-ray examination, anesthetic, medical or surgical diagnosis or treatment, and hospital care under the general or special supervision and upon the advice of or to be rendered by a physician and surgeon licensed under the Medical Practice Act. "Dental Care" means X-ray examination, anesthetic, dental or surgical diagnosis or treatment, and hospital care by a dentist licensed under the Dental Practice Act. Along with this, I understand that all costs involved with such mentioned "Medical Care" and "Dental Care" is my sole responsibility. Further, I hereby authorize any hospital, which has provided treatment to my child to surrender physical custody of my child to Devil's Thumb Ranch Operating Company Inc., its employees, and agents upon the completion of treatment.

First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information

To properly size equipment for your activity, please provide your height, weight and shoe size in the box provided.

HEALTH STATEMENT 

The proposed activity provided by DTR Horse Operations LLC requires participation in physical exercises which are, by their nature, physically demanding. Many of the activities will challenge you, and cause surges in blood pressure and pulse rates. It is imperative that you are free of any heart or any other diseases. Therefore, all participants must be free of medical or physical conditions which might create undue risks to themselves or any others who depend on them. If there is any doubt about your ability to safely participate in this experience, you should have a physical examination.

HEALTH HISTORY: (Select the appropriate answers and describe any YES answers)

HAVE YOU OR DO YOU CURRENTLY HAVE ANY HEART PROBLEMS?*
No
Yes
DO YOU FREQUENTLY SUFFER FROM PAINS IN YOUR CHEST?*
No
Yes
DO YOU OFTEN FEEL FAINT OR HAVE SPELLS OF SEVERE DIZZINESS?*
No
Yes
HAS YOUR DOCTOR EVER TOLD YOU THAT YOU HAVE HIGH BLOOD PRESSURE?*
No
Yes
ARE YOU A SMOKER?*
No
Yes
DO YOU HAVE ARTHRITIS, JOINT, OR BACK PROBLEMS THAT MAY BE AGGRAVATED BY EXERCISE?*
No
Yes
DO YOU HAVE ASTHMA OR ANY OTHER RESPIRATORY ISSUES?*
No
Yes
HAVE YOU HAD ANY OPERATIONS OR SERIOUS INJURIES?*
No
Yes
ARE THERE ANY ACTIVITIES TO BE LIMITED/DISCOURAGED BY PHYSICIAN'S ADVICE?*
No
Yes
ARE YOU ALLERGIC TO ANY MEDICINES, INSECTS, OR POLLEN?*
No
Yes
DO YOU HAVE EPILEPSY?*
No
Yes
DO YOU HAVE DIABETES?*
No
Yes
(Horseback Riding and Biking ONLY) WILL YOU BE ELECTING TO WEAR A HELMET FOR THIS ACTIVITY*
Yes
No
Brought My Own

(Only Fill out if answered yes to any of the above questions) BRIEFLY EXPLAIN AREAS OF CONCERN

Representation and Emergency Authorization:
This health history is correct so far as I know, and I believe that my health is satisfactory to participate in challenge course activities. In the event I suffer any sickness, accident or injury, Devil's Thumb Ranch Operating Company Inc. and DTR Horse Operations LLC, its employees, and agents, have my express permission to secure such medical treatment as deemed necessary in their sole discretion. I hereby give my consent to Devil's Thumb Ranch Operating Company Inc. and DTR Horse Operations LLC, its employees, and agents to consent to "Medical Care" and "Dental Care" for me. "Medical Care" means X-ray examination, anesthetic, medical or surgical diagnosis or treatment, and hospital care under the general or special supervision and upon the advice of or to be rendered by a physician and surgeon licensed under the Medical Practice Act. "Dental Care" means X-ray examination, anesthetic, dental or surgical diagnosis or treatment, and hospital care by a dentist licensed under the Dental Practice Act. Along with this, I understand that all costs involved with such mentioned "Medical Care" and "Dental Care" is my sole responsibility. Further, I hereby authorize any hospital, which has provided treatment to my child to surrender physical custody of my child to Devil's Thumb Ranch Operating Company Inc., its employees, and agents upon the completion of treatment.

Third Participant's Name

First Name*

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

To properly size equipment for your activity, please provide your height, weight and shoe size in the box provided.

HEALTH STATEMENT 

The proposed activity provided by DTR Horse Operations LLC requires participation in physical exercises which are, by their nature, physically demanding. Many of the activities will challenge you, and cause surges in blood pressure and pulse rates. It is imperative that you are free of any heart or any other diseases. Therefore, all participants must be free of medical or physical conditions which might create undue risks to themselves or any others who depend on them. If there is any doubt about your ability to safely participate in this experience, you should have a physical examination.

HEALTH HISTORY: (Select the appropriate answers and describe any YES answers)

HAVE YOU OR DO YOU CURRENTLY HAVE ANY HEART PROBLEMS?*
No
Yes
DO YOU FREQUENTLY SUFFER FROM PAINS IN YOUR CHEST?*
No
Yes
DO YOU OFTEN FEEL FAINT OR HAVE SPELLS OF SEVERE DIZZINESS?*
No
Yes
HAS YOUR DOCTOR EVER TOLD YOU THAT YOU HAVE HIGH BLOOD PRESSURE?*
No
Yes
ARE YOU A SMOKER?*
No
Yes
DO YOU HAVE ARTHRITIS, JOINT, OR BACK PROBLEMS THAT MAY BE AGGRAVATED BY EXERCISE?*
No
Yes
DO YOU HAVE ASTHMA OR ANY OTHER RESPIRATORY ISSUES?*
No
Yes
HAVE YOU HAD ANY OPERATIONS OR SERIOUS INJURIES?*
No
Yes
ARE THERE ANY ACTIVITIES TO BE LIMITED/DISCOURAGED BY PHYSICIAN'S ADVICE?*
No
Yes
ARE YOU ALLERGIC TO ANY MEDICINES, INSECTS, OR POLLEN?*
No
Yes
DO YOU HAVE EPILEPSY?*
No
Yes
DO YOU HAVE DIABETES?*
No
Yes
(Horseback Riding and Biking ONLY) WILL YOU BE ELECTING TO WEAR A HELMET FOR THIS ACTIVITY*
Yes
No
Brought My Own

(Only Fill out if answered yes to any of the above questions) BRIEFLY EXPLAIN AREAS OF CONCERN

Representation and Emergency Authorization:
This health history is correct so far as I know, and I believe that my health is satisfactory to participate in challenge course activities. In the event I suffer any sickness, accident or injury, Devil's Thumb Ranch Operating Company Inc. and DTR Horse Operations LLC, its employees, and agents, have my express permission to secure such medical treatment as deemed necessary in their sole discretion. I hereby give my consent to Devil's Thumb Ranch Operating Company Inc. and DTR Horse Operations LLC, its employees, and agents to consent to "Medical Care" and "Dental Care" for me. "Medical Care" means X-ray examination, anesthetic, medical or surgical diagnosis or treatment, and hospital care under the general or special supervision and upon the advice of or to be rendered by a physician and surgeon licensed under the Medical Practice Act. "Dental Care" means X-ray examination, anesthetic, dental or surgical diagnosis or treatment, and hospital care by a dentist licensed under the Dental Practice Act. Along with this, I understand that all costs involved with such mentioned "Medical Care" and "Dental Care" is my sole responsibility. Further, I hereby authorize any hospital, which has provided treatment to my child to surrender physical custody of my child to Devil's Thumb Ranch Operating Company Inc., its employees, and agents upon the completion of treatment.

Fourth Participant's Name

First Name*

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

To properly size equipment for your activity, please provide your height, weight and shoe size in the box provided.

HEALTH STATEMENT 

The proposed activity provided by DTR Horse Operations LLC requires participation in physical exercises which are, by their nature, physically demanding. Many of the activities will challenge you, and cause surges in blood pressure and pulse rates. It is imperative that you are free of any heart or any other diseases. Therefore, all participants must be free of medical or physical conditions which might create undue risks to themselves or any others who depend on them. If there is any doubt about your ability to safely participate in this experience, you should have a physical examination.

HEALTH HISTORY: (Select the appropriate answers and describe any YES answers)

HAVE YOU OR DO YOU CURRENTLY HAVE ANY HEART PROBLEMS?*
No
Yes
DO YOU FREQUENTLY SUFFER FROM PAINS IN YOUR CHEST?*
No
Yes
DO YOU OFTEN FEEL FAINT OR HAVE SPELLS OF SEVERE DIZZINESS?*
No
Yes
HAS YOUR DOCTOR EVER TOLD YOU THAT YOU HAVE HIGH BLOOD PRESSURE?*
No
Yes
ARE YOU A SMOKER?*
No
Yes
DO YOU HAVE ARTHRITIS, JOINT, OR BACK PROBLEMS THAT MAY BE AGGRAVATED BY EXERCISE?*
No
Yes
DO YOU HAVE ASTHMA OR ANY OTHER RESPIRATORY ISSUES?*
No
Yes
HAVE YOU HAD ANY OPERATIONS OR SERIOUS INJURIES?*
No
Yes
ARE THERE ANY ACTIVITIES TO BE LIMITED/DISCOURAGED BY PHYSICIAN'S ADVICE?*
No
Yes
ARE YOU ALLERGIC TO ANY MEDICINES, INSECTS, OR POLLEN?*
No
Yes
DO YOU HAVE EPILEPSY?*
No
Yes
DO YOU HAVE DIABETES?*
No
Yes
(Horseback Riding and Biking ONLY) WILL YOU BE ELECTING TO WEAR A HELMET FOR THIS ACTIVITY*
Yes
No
Brought My Own

(Only Fill out if answered yes to any of the above questions) BRIEFLY EXPLAIN AREAS OF CONCERN

Representation and Emergency Authorization:
This health history is correct so far as I know, and I believe that my health is satisfactory to participate in challenge course activities. In the event I suffer any sickness, accident or injury, Devil's Thumb Ranch Operating Company Inc. and DTR Horse Operations LLC, its employees, and agents, have my express permission to secure such medical treatment as deemed necessary in their sole discretion. I hereby give my consent to Devil's Thumb Ranch Operating Company Inc. and DTR Horse Operations LLC, its employees, and agents to consent to "Medical Care" and "Dental Care" for me. "Medical Care" means X-ray examination, anesthetic, medical or surgical diagnosis or treatment, and hospital care under the general or special supervision and upon the advice of or to be rendered by a physician and surgeon licensed under the Medical Practice Act. "Dental Care" means X-ray examination, anesthetic, dental or surgical diagnosis or treatment, and hospital care by a dentist licensed under the Dental Practice Act. Along with this, I understand that all costs involved with such mentioned "Medical Care" and "Dental Care" is my sole responsibility. Further, I hereby authorize any hospital, which has provided treatment to my child to surrender physical custody of my child to Devil's Thumb Ranch Operating Company Inc., its employees, and agents upon the completion of treatment.

Fifth Participant's Name

First Name*

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

To properly size equipment for your activity, please provide your height, weight and shoe size in the box provided.

HEALTH STATEMENT 

The proposed activity provided by DTR Horse Operations LLC requires participation in physical exercises which are, by their nature, physically demanding. Many of the activities will challenge you, and cause surges in blood pressure and pulse rates. It is imperative that you are free of any heart or any other diseases. Therefore, all participants must be free of medical or physical conditions which might create undue risks to themselves or any others who depend on them. If there is any doubt about your ability to safely participate in this experience, you should have a physical examination.

HEALTH HISTORY: (Select the appropriate answers and describe any YES answers)

HAVE YOU OR DO YOU CURRENTLY HAVE ANY HEART PROBLEMS?*
No
Yes
DO YOU FREQUENTLY SUFFER FROM PAINS IN YOUR CHEST?*
No
Yes
DO YOU OFTEN FEEL FAINT OR HAVE SPELLS OF SEVERE DIZZINESS?*
No
Yes
HAS YOUR DOCTOR EVER TOLD YOU THAT YOU HAVE HIGH BLOOD PRESSURE?*
No
Yes
ARE YOU A SMOKER?*
No
Yes
DO YOU HAVE ARTHRITIS, JOINT, OR BACK PROBLEMS THAT MAY BE AGGRAVATED BY EXERCISE?*
No
Yes
DO YOU HAVE ASTHMA OR ANY OTHER RESPIRATORY ISSUES?*
No
Yes
HAVE YOU HAD ANY OPERATIONS OR SERIOUS INJURIES?*
No
Yes
ARE THERE ANY ACTIVITIES TO BE LIMITED/DISCOURAGED BY PHYSICIAN'S ADVICE?*
No
Yes
ARE YOU ALLERGIC TO ANY MEDICINES, INSECTS, OR POLLEN?*
No
Yes
DO YOU HAVE EPILEPSY?*
No
Yes
DO YOU HAVE DIABETES?*
No
Yes
(Horseback Riding and Biking ONLY) WILL YOU BE ELECTING TO WEAR A HELMET FOR THIS ACTIVITY*
Yes
No
Brought My Own

(Only Fill out if answered yes to any of the above questions) BRIEFLY EXPLAIN AREAS OF CONCERN

Representation and Emergency Authorization:
This health history is correct so far as I know, and I believe that my health is satisfactory to participate in challenge course activities. In the event I suffer any sickness, accident or injury, Devil's Thumb Ranch Operating Company Inc. and DTR Horse Operations LLC, its employees, and agents, have my express permission to secure such medical treatment as deemed necessary in their sole discretion. I hereby give my consent to Devil's Thumb Ranch Operating Company Inc. and DTR Horse Operations LLC, its employees, and agents to consent to "Medical Care" and "Dental Care" for me. "Medical Care" means X-ray examination, anesthetic, medical or surgical diagnosis or treatment, and hospital care under the general or special supervision and upon the advice of or to be rendered by a physician and surgeon licensed under the Medical Practice Act. "Dental Care" means X-ray examination, anesthetic, dental or surgical diagnosis or treatment, and hospital care by a dentist licensed under the Dental Practice Act. Along with this, I understand that all costs involved with such mentioned "Medical Care" and "Dental Care" is my sole responsibility. Further, I hereby authorize any hospital, which has provided treatment to my child to surrender physical custody of my child to Devil's Thumb Ranch Operating Company Inc., its employees, and agents upon the completion of treatment.

Sixth Participant's Name

First Name*

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

To properly size equipment for your activity, please provide your height, weight and shoe size in the box provided.

HEALTH STATEMENT 

The proposed activity provided by DTR Horse Operations LLC requires participation in physical exercises which are, by their nature, physically demanding. Many of the activities will challenge you, and cause surges in blood pressure and pulse rates. It is imperative that you are free of any heart or any other diseases. Therefore, all participants must be free of medical or physical conditions which might create undue risks to themselves or any others who depend on them. If there is any doubt about your ability to safely participate in this experience, you should have a physical examination.

HEALTH HISTORY: (Select the appropriate answers and describe any YES answers)

HAVE YOU OR DO YOU CURRENTLY HAVE ANY HEART PROBLEMS?*
No
Yes
DO YOU FREQUENTLY SUFFER FROM PAINS IN YOUR CHEST?*
No
Yes
DO YOU OFTEN FEEL FAINT OR HAVE SPELLS OF SEVERE DIZZINESS?*
No
Yes
HAS YOUR DOCTOR EVER TOLD YOU THAT YOU HAVE HIGH BLOOD PRESSURE?*
No
Yes
ARE YOU A SMOKER?*
No
Yes
DO YOU HAVE ARTHRITIS, JOINT, OR BACK PROBLEMS THAT MAY BE AGGRAVATED BY EXERCISE?*
No
Yes
DO YOU HAVE ASTHMA OR ANY OTHER RESPIRATORY ISSUES?*
No
Yes
HAVE YOU HAD ANY OPERATIONS OR SERIOUS INJURIES?*
No
Yes
ARE THERE ANY ACTIVITIES TO BE LIMITED/DISCOURAGED BY PHYSICIAN'S ADVICE?*
No
Yes
ARE YOU ALLERGIC TO ANY MEDICINES, INSECTS, OR POLLEN?*
No
Yes
DO YOU HAVE EPILEPSY?*
No
Yes
DO YOU HAVE DIABETES?*
No
Yes
(Horseback Riding and Biking ONLY) WILL YOU BE ELECTING TO WEAR A HELMET FOR THIS ACTIVITY*
Yes
No
Brought My Own

(Only Fill out if answered yes to any of the above questions) BRIEFLY EXPLAIN AREAS OF CONCERN

Representation and Emergency Authorization:
This health history is correct so far as I know, and I believe that my health is satisfactory to participate in challenge course activities. In the event I suffer any sickness, accident or injury, Devil's Thumb Ranch Operating Company Inc. and DTR Horse Operations LLC, its employees, and agents, have my express permission to secure such medical treatment as deemed necessary in their sole discretion. I hereby give my consent to Devil's Thumb Ranch Operating Company Inc. and DTR Horse Operations LLC, its employees, and agents to consent to "Medical Care" and "Dental Care" for me. "Medical Care" means X-ray examination, anesthetic, medical or surgical diagnosis or treatment, and hospital care under the general or special supervision and upon the advice of or to be rendered by a physician and surgeon licensed under the Medical Practice Act. "Dental Care" means X-ray examination, anesthetic, dental or surgical diagnosis or treatment, and hospital care by a dentist licensed under the Dental Practice Act. Along with this, I understand that all costs involved with such mentioned "Medical Care" and "Dental Care" is my sole responsibility. Further, I hereby authorize any hospital, which has provided treatment to my child to surrender physical custody of my child to Devil's Thumb Ranch Operating Company Inc., its employees, and agents upon the completion of treatment.

Seventh Participant's Name

First Name*

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

To properly size equipment for your activity, please provide your height, weight and shoe size in the box provided.

HEALTH STATEMENT 

The proposed activity provided by DTR Horse Operations LLC requires participation in physical exercises which are, by their nature, physically demanding. Many of the activities will challenge you, and cause surges in blood pressure and pulse rates. It is imperative that you are free of any heart or any other diseases. Therefore, all participants must be free of medical or physical conditions which might create undue risks to themselves or any others who depend on them. If there is any doubt about your ability to safely participate in this experience, you should have a physical examination.

HEALTH HISTORY: (Select the appropriate answers and describe any YES answers)

HAVE YOU OR DO YOU CURRENTLY HAVE ANY HEART PROBLEMS?*
No
Yes
DO YOU FREQUENTLY SUFFER FROM PAINS IN YOUR CHEST?*
No
Yes
DO YOU OFTEN FEEL FAINT OR HAVE SPELLS OF SEVERE DIZZINESS?*
No
Yes
HAS YOUR DOCTOR EVER TOLD YOU THAT YOU HAVE HIGH BLOOD PRESSURE?*
No
Yes
ARE YOU A SMOKER?*
No
Yes
DO YOU HAVE ARTHRITIS, JOINT, OR BACK PROBLEMS THAT MAY BE AGGRAVATED BY EXERCISE?*
No
Yes
DO YOU HAVE ASTHMA OR ANY OTHER RESPIRATORY ISSUES?*
No
Yes
HAVE YOU HAD ANY OPERATIONS OR SERIOUS INJURIES?*
No
Yes
ARE THERE ANY ACTIVITIES TO BE LIMITED/DISCOURAGED BY PHYSICIAN'S ADVICE?*
No
Yes
ARE YOU ALLERGIC TO ANY MEDICINES, INSECTS, OR POLLEN?*
No
Yes
DO YOU HAVE EPILEPSY?*
No
Yes
DO YOU HAVE DIABETES?*
No
Yes
(Horseback Riding and Biking ONLY) WILL YOU BE ELECTING TO WEAR A HELMET FOR THIS ACTIVITY*
Yes
No
Brought My Own

(Only Fill out if answered yes to any of the above questions) BRIEFLY EXPLAIN AREAS OF CONCERN

Representation and Emergency Authorization:
This health history is correct so far as I know, and I believe that my health is satisfactory to participate in challenge course activities. In the event I suffer any sickness, accident or injury, Devil's Thumb Ranch Operating Company Inc. and DTR Horse Operations LLC, its employees, and agents, have my express permission to secure such medical treatment as deemed necessary in their sole discretion. I hereby give my consent to Devil's Thumb Ranch Operating Company Inc. and DTR Horse Operations LLC, its employees, and agents to consent to "Medical Care" and "Dental Care" for me. "Medical Care" means X-ray examination, anesthetic, medical or surgical diagnosis or treatment, and hospital care under the general or special supervision and upon the advice of or to be rendered by a physician and surgeon licensed under the Medical Practice Act. "Dental Care" means X-ray examination, anesthetic, dental or surgical diagnosis or treatment, and hospital care by a dentist licensed under the Dental Practice Act. Along with this, I understand that all costs involved with such mentioned "Medical Care" and "Dental Care" is my sole responsibility. Further, I hereby authorize any hospital, which has provided treatment to my child to surrender physical custody of my child to Devil's Thumb Ranch Operating Company Inc., its employees, and agents upon the completion of treatment.

Eighth Participant's Name

First Name*

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

To properly size equipment for your activity, please provide your height, weight and shoe size in the box provided.

HEALTH STATEMENT 

The proposed activity provided by DTR Horse Operations LLC requires participation in physical exercises which are, by their nature, physically demanding. Many of the activities will challenge you, and cause surges in blood pressure and pulse rates. It is imperative that you are free of any heart or any other diseases. Therefore, all participants must be free of medical or physical conditions which might create undue risks to themselves or any others who depend on them. If there is any doubt about your ability to safely participate in this experience, you should have a physical examination.

HEALTH HISTORY: (Select the appropriate answers and describe any YES answers)

HAVE YOU OR DO YOU CURRENTLY HAVE ANY HEART PROBLEMS?*
No
Yes
DO YOU FREQUENTLY SUFFER FROM PAINS IN YOUR CHEST?*
No
Yes
DO YOU OFTEN FEEL FAINT OR HAVE SPELLS OF SEVERE DIZZINESS?*
No
Yes
HAS YOUR DOCTOR EVER TOLD YOU THAT YOU HAVE HIGH BLOOD PRESSURE?*
No
Yes
ARE YOU A SMOKER?*
No
Yes
DO YOU HAVE ARTHRITIS, JOINT, OR BACK PROBLEMS THAT MAY BE AGGRAVATED BY EXERCISE?*
No
Yes
DO YOU HAVE ASTHMA OR ANY OTHER RESPIRATORY ISSUES?*
No
Yes
HAVE YOU HAD ANY OPERATIONS OR SERIOUS INJURIES?*
No
Yes
ARE THERE ANY ACTIVITIES TO BE LIMITED/DISCOURAGED BY PHYSICIAN'S ADVICE?*
No
Yes
ARE YOU ALLERGIC TO ANY MEDICINES, INSECTS, OR POLLEN?*
No
Yes
DO YOU HAVE EPILEPSY?*
No
Yes
DO YOU HAVE DIABETES?*
No
Yes
(Horseback Riding and Biking ONLY) WILL YOU BE ELECTING TO WEAR A HELMET FOR THIS ACTIVITY*
Yes
No
Brought My Own

(Only Fill out if answered yes to any of the above questions) BRIEFLY EXPLAIN AREAS OF CONCERN

Representation and Emergency Authorization:
This health history is correct so far as I know, and I believe that my health is satisfactory to participate in challenge course activities. In the event I suffer any sickness, accident or injury, Devil's Thumb Ranch Operating Company Inc. and DTR Horse Operations LLC, its employees, and agents, have my express permission to secure such medical treatment as deemed necessary in their sole discretion. I hereby give my consent to Devil's Thumb Ranch Operating Company Inc. and DTR Horse Operations LLC, its employees, and agents to consent to "Medical Care" and "Dental Care" for me. "Medical Care" means X-ray examination, anesthetic, medical or surgical diagnosis or treatment, and hospital care under the general or special supervision and upon the advice of or to be rendered by a physician and surgeon licensed under the Medical Practice Act. "Dental Care" means X-ray examination, anesthetic, dental or surgical diagnosis or treatment, and hospital care by a dentist licensed under the Dental Practice Act. Along with this, I understand that all costs involved with such mentioned "Medical Care" and "Dental Care" is my sole responsibility. Further, I hereby authorize any hospital, which has provided treatment to my child to surrender physical custody of my child to Devil's Thumb Ranch Operating Company Inc., its employees, and agents upon the completion of treatment.

Ninth Participant's Name

First Name*

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

To properly size equipment for your activity, please provide your height, weight and shoe size in the box provided.

HEALTH STATEMENT 

The proposed activity provided by DTR Horse Operations LLC requires participation in physical exercises which are, by their nature, physically demanding. Many of the activities will challenge you, and cause surges in blood pressure and pulse rates. It is imperative that you are free of any heart or any other diseases. Therefore, all participants must be free of medical or physical conditions which might create undue risks to themselves or any others who depend on them. If there is any doubt about your ability to safely participate in this experience, you should have a physical examination.

HEALTH HISTORY: (Select the appropriate answers and describe any YES answers)

HAVE YOU OR DO YOU CURRENTLY HAVE ANY HEART PROBLEMS?*
No
Yes
DO YOU FREQUENTLY SUFFER FROM PAINS IN YOUR CHEST?*
No
Yes
DO YOU OFTEN FEEL FAINT OR HAVE SPELLS OF SEVERE DIZZINESS?*
No
Yes
HAS YOUR DOCTOR EVER TOLD YOU THAT YOU HAVE HIGH BLOOD PRESSURE?*
No
Yes
ARE YOU A SMOKER?*
No
Yes
DO YOU HAVE ARTHRITIS, JOINT, OR BACK PROBLEMS THAT MAY BE AGGRAVATED BY EXERCISE?*
No
Yes
DO YOU HAVE ASTHMA OR ANY OTHER RESPIRATORY ISSUES?*
No
Yes
HAVE YOU HAD ANY OPERATIONS OR SERIOUS INJURIES?*
No
Yes
ARE THERE ANY ACTIVITIES TO BE LIMITED/DISCOURAGED BY PHYSICIAN'S ADVICE?*
No
Yes
ARE YOU ALLERGIC TO ANY MEDICINES, INSECTS, OR POLLEN?*
No
Yes
DO YOU HAVE EPILEPSY?*
No
Yes
DO YOU HAVE DIABETES?*
No
Yes
(Horseback Riding and Biking ONLY) WILL YOU BE ELECTING TO WEAR A HELMET FOR THIS ACTIVITY*
Yes
No
Brought My Own

(Only Fill out if answered yes to any of the above questions) BRIEFLY EXPLAIN AREAS OF CONCERN

Representation and Emergency Authorization:
This health history is correct so far as I know, and I believe that my health is satisfactory to participate in challenge course activities. In the event I suffer any sickness, accident or injury, Devil's Thumb Ranch Operating Company Inc. and DTR Horse Operations LLC, its employees, and agents, have my express permission to secure such medical treatment as deemed necessary in their sole discretion. I hereby give my consent to Devil's Thumb Ranch Operating Company Inc. and DTR Horse Operations LLC, its employees, and agents to consent to "Medical Care" and "Dental Care" for me. "Medical Care" means X-ray examination, anesthetic, medical or surgical diagnosis or treatment, and hospital care under the general or special supervision and upon the advice of or to be rendered by a physician and surgeon licensed under the Medical Practice Act. "Dental Care" means X-ray examination, anesthetic, dental or surgical diagnosis or treatment, and hospital care by a dentist licensed under the Dental Practice Act. Along with this, I understand that all costs involved with such mentioned "Medical Care" and "Dental Care" is my sole responsibility. Further, I hereby authorize any hospital, which has provided treatment to my child to surrender physical custody of my child to Devil's Thumb Ranch Operating Company Inc., its employees, and agents upon the completion of treatment.

Tenth Participant's Name

First Name*

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

To properly size equipment for your activity, please provide your height, weight and shoe size in the box provided.

HEALTH STATEMENT 

The proposed activity provided by DTR Horse Operations LLC requires participation in physical exercises which are, by their nature, physically demanding. Many of the activities will challenge you, and cause surges in blood pressure and pulse rates. It is imperative that you are free of any heart or any other diseases. Therefore, all participants must be free of medical or physical conditions which might create undue risks to themselves or any others who depend on them. If there is any doubt about your ability to safely participate in this experience, you should have a physical examination.

HEALTH HISTORY: (Select the appropriate answers and describe any YES answers)

HAVE YOU OR DO YOU CURRENTLY HAVE ANY HEART PROBLEMS?*
No
Yes
DO YOU FREQUENTLY SUFFER FROM PAINS IN YOUR CHEST?*
No
Yes
DO YOU OFTEN FEEL FAINT OR HAVE SPELLS OF SEVERE DIZZINESS?*
No
Yes
HAS YOUR DOCTOR EVER TOLD YOU THAT YOU HAVE HIGH BLOOD PRESSURE?*
No
Yes
ARE YOU A SMOKER?*
No
Yes
DO YOU HAVE ARTHRITIS, JOINT, OR BACK PROBLEMS THAT MAY BE AGGRAVATED BY EXERCISE?*
No
Yes
DO YOU HAVE ASTHMA OR ANY OTHER RESPIRATORY ISSUES?*
No
Yes
HAVE YOU HAD ANY OPERATIONS OR SERIOUS INJURIES?*
No
Yes
ARE THERE ANY ACTIVITIES TO BE LIMITED/DISCOURAGED BY PHYSICIAN'S ADVICE?*
No
Yes
ARE YOU ALLERGIC TO ANY MEDICINES, INSECTS, OR POLLEN?*
No
Yes
DO YOU HAVE EPILEPSY?*
No
Yes
DO YOU HAVE DIABETES?*
No
Yes
(Horseback Riding and Biking ONLY) WILL YOU BE ELECTING TO WEAR A HELMET FOR THIS ACTIVITY*
Yes
No
Brought My Own

(Only Fill out if answered yes to any of the above questions) BRIEFLY EXPLAIN AREAS OF CONCERN

Representation and Emergency Authorization:
This health history is correct so far as I know, and I believe that my health is satisfactory to participate in challenge course activities. In the event I suffer any sickness, accident or injury, Devil's Thumb Ranch Operating Company Inc. and DTR Horse Operations LLC, its employees, and agents, have my express permission to secure such medical treatment as deemed necessary in their sole discretion. I hereby give my consent to Devil's Thumb Ranch Operating Company Inc. and DTR Horse Operations LLC, its employees, and agents to consent to "Medical Care" and "Dental Care" for me. "Medical Care" means X-ray examination, anesthetic, medical or surgical diagnosis or treatment, and hospital care under the general or special supervision and upon the advice of or to be rendered by a physician and surgeon licensed under the Medical Practice Act. "Dental Care" means X-ray examination, anesthetic, dental or surgical diagnosis or treatment, and hospital care by a dentist licensed under the Dental Practice Act. Along with this, I understand that all costs involved with such mentioned "Medical Care" and "Dental Care" is my sole responsibility. Further, I hereby authorize any hospital, which has provided treatment to my child to surrender physical custody of my child to Devil's Thumb Ranch Operating Company Inc., its employees, and agents upon the completion of treatment.

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*
FOR PARENTS/GUARDIANS/CUSTODIANS OF PARTICIPANTS OF MINORITY AGE (Under age of 18 at time of registration): This is to certify that I as a parent/guardian/custodian with legal responsibility for this participant do consent and agree to his/her release to participate in the trip and further agree, individually and on behalf of the minor participant to the terms above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information

To properly size equipment for your activity, please provide your height, weight and shoe size in the box provided.

HEALTH STATEMENT 

The proposed activity provided by DTR Horse Operations LLC requires participation in physical exercises which are, by their nature, physically demanding. Many of the activities will challenge you, and cause surges in blood pressure and pulse rates. It is imperative that you are free of any heart or any other diseases. Therefore, all participants must be free of medical or physical conditions which might create undue risks to themselves or any others who depend on them. If there is any doubt about your ability to safely participate in this experience, you should have a physical examination.

HEALTH HISTORY: (Select the appropriate answers and describe any YES answers)

HAVE YOU OR DO YOU CURRENTLY HAVE ANY HEART PROBLEMS?*
No
Yes
DO YOU FREQUENTLY SUFFER FROM PAINS IN YOUR CHEST?*
No
Yes
DO YOU OFTEN FEEL FAINT OR HAVE SPELLS OF SEVERE DIZZINESS?*
No
Yes
HAS YOUR DOCTOR EVER TOLD YOU THAT YOU HAVE HIGH BLOOD PRESSURE?*
No
Yes
ARE YOU A SMOKER?*
No
Yes
DO YOU HAVE ARTHRITIS, JOINT, OR BACK PROBLEMS THAT MAY BE AGGRAVATED BY EXERCISE?*
No
Yes
DO YOU HAVE ASTHMA OR ANY OTHER RESPIRATORY ISSUES?*
No
Yes
HAVE YOU HAD ANY OPERATIONS OR SERIOUS INJURIES?*
No
Yes
ARE THERE ANY ACTIVITIES TO BE LIMITED/DISCOURAGED BY PHYSICIAN'S ADVICE?*
No
Yes
ARE YOU ALLERGIC TO ANY MEDICINES, INSECTS, OR POLLEN?*
No
Yes
DO YOU HAVE EPILEPSY?*
No
Yes
DO YOU HAVE DIABETES?*
No
Yes
(Horseback Riding and Biking ONLY) WILL YOU BE ELECTING TO WEAR A HELMET FOR THIS ACTIVITY*
Yes
No
Brought My Own

(Only Fill out if answered yes to any of the above questions) BRIEFLY EXPLAIN AREAS OF CONCERN

Representation and Emergency Authorization:
This health history is correct so far as I know, and I believe that my health is satisfactory to participate in challenge course activities. In the event I suffer any sickness, accident or injury, Devil's Thumb Ranch Operating Company Inc. and DTR Horse Operations LLC, its employees, and agents, have my express permission to secure such medical treatment as deemed necessary in their sole discretion. I hereby give my consent to Devil's Thumb Ranch Operating Company Inc. and DTR Horse Operations LLC, its employees, and agents to consent to "Medical Care" and "Dental Care" for me. "Medical Care" means X-ray examination, anesthetic, medical or surgical diagnosis or treatment, and hospital care under the general or special supervision and upon the advice of or to be rendered by a physician and surgeon licensed under the Medical Practice Act. "Dental Care" means X-ray examination, anesthetic, dental or surgical diagnosis or treatment, and hospital care by a dentist licensed under the Dental Practice Act. Along with this, I understand that all costs involved with such mentioned "Medical Care" and "Dental Care" is my sole responsibility. Further, I hereby authorize any hospital, which has provided treatment to my child to surrender physical custody of my child to Devil's Thumb Ranch Operating Company Inc., its employees, and agents upon the completion of treatment.

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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