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2020 Membership Form and Waiver

Thank you for joining Abundant Life Adventure Club!

You only have to fill this out once a year. This form is valid from January 1, 2020 until December 31, 2020.

Please read carefully before signing as this affects your legal rights.

 

 RELEASE OF LIABILITY, WAIVER OF CLAIMS,  ASSUMPTION OF RISK AGREEMENT, AUTHORIZATION FOR EMERGENCY TREATMENT OR TRANSPORTATION, DECLARATION OF FITNESS, AND PHOTO RELEASE.

I, the undersigned, as participant, or as parent or legal guardian of the child listed on this form, hereby assume full responsibility for all risk of injury or loss which may result from my or my child’s participation in the program listed below, and hereby agree to hold harmless, release and forever discharge Abundant Life Adventure Club, its officers, directors, agents and employees and their representatives, from any and all claims and demands whatsoever which the undersigned, and any of them or any third party and their representatives or any person acting under their behalf have, or may have, against Abundant Life Adventure Club by reason of any accident, illness, injury, or death to any person or persons, or damage to, loss of or destruction of property arising or resulting directly or indirectly from my or my child’s participation in the aforementioned activity, and occurring during said participation, or anytime subsequent thereto regardless of whether said claims or demands arise out of negligence on the part of Abundant Life Adventure Club or its leadership. The terms of this release shall serve as a release and assumption of risk for myself, my child, heirs, executives, administrators, and for all of my family members.

I Agree

Declaration of Fitness Agreement: I understand, agree, and acknowledge that some activities in this program may be of a hazardous nature and/or include physical and/or strenuous activity. I hereby assume all risk of such activities. Understanding this, I state to the best of my knowledge that I or my child listed on this form have no medical, physical, mental, or emotional health conditions which would hinder my or my child’s active participation in the program listed on this form.

Furthermore, I hereby declare that I am physically fit and that I have no physical or mental condition(s) that should preclude me from participating in my chosen activity, that I am not participating against medical advice or treatment and that I have not been diagnosed by a registered doctor as having a terminal illness. I further declare that in the event that I feel ill or unwell, have any physical complaints whatsoever or if an injury is sustained of any kind during the course of hiking activities, I will notify the guide immediately and before moving away from the immediate vicinity.

In the case of an emergency in which I am not able to give permission for medical treatment and my designated emergency contact cannot be reached, I authorize the staff or agents of Abundant Life Adventure Club to obtain whatever medical treatment is deemed necessary for my or my child’s welfare. In the case of my child, this authorization is given pursuant to the provisions of the laws of my state. I further understand and agree that I will be financially responsible for all charges and fees incurred in the rendering of said emergency treatment, regardless of whether my medical insurance would cover such charges and fees.

I Agree

PHOTO RELEASE:​ I hereby grant Abundant Life Adventure Club permission to use my likeness in a photograph, video, or other digital media (photo) in any and all of its publications, including web-based publications, without payment or other consideration. Should I object to a photo of me being posted or shared by another member, I understand that I need to contact that member directly and ask him/her to remove or take down the image as Abundant Life Adventure Club is not involved or responsible for that situation.

I Agree

 

First Member Name

First Name*

Last Name*

Phone*
First Member Date of Birth*
First Member Signature*
Second Member Name

First Name*

Last Name*
Second Member Date of Birth*
Third Member Name

First Name*

Last Name*
Third Member Date of Birth*
Fourth Member Name

First Name*

Last Name*
Fourth Member Date of Birth*
Fifth Member Name

First Name*

Last Name*
Fifth Member Date of Birth*
Sixth Member Name

First Name*

Last Name*
Sixth Member Date of Birth*
Seventh Member Name

First Name*

Last Name*
Seventh Member Date of Birth*
Eighth Member Name

First Name*

Last Name*
Eighth Member Date of Birth*
Ninth Member Name

First Name*

Last Name*
Ninth Member Date of Birth*
Tenth Member Name

First Name*

Last Name*
Tenth Member Date of Birth*
Parent or Guardian's Email Address

Email*
Check to receive information on events, 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*
What city and state do you live in?

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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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