TODAY'S DATE:February 20, 2024


Please make your signature here; at the end of the document, you will be asked to apply your electronic signature which will confirm that the medical information you are about to complete is correct.

If your child is a participant and you are a parent/guardian completing this form, please click on the "Minor" button and answer all questions on behalf of your child:

Please select who will be participating...
First Participant Name

First Name*

Last Name*
First Participant Age Acknowledgment*
First Participant Date of Birth*
I certify that I am 18 years of age or older
First Participant Information
Please select the program you're participating in from this list*
First Participant Signature*
Parent or Guardian's Email Address


Confirm Email*
Release, Indemnification, and waiver form

This is a release -- please read it carefully.

At Vermont Wilderness School, the safety of each student is our highest priority. We take all reasonable precautions to ensure you and/or your child's physical and emotional safety and to provide a quality experience that focuses on fun, safety and character development. However, as in any other experience, we cannot eliminate all risks from our programs, even in a distance-learning context.

The risks include but are not limited to: insect and animal bites and stings; forces of nature such as but not limited to lightning, illness, disease and unexpected extreme weather conditions; and any hazard present in the wilderness, such as but not limited to low lying branches, sharp objects, and slippery surfaces.

I, the undersigned, hereby acknowledge that I have been advised and fully understand that certain elements of danger are inherent in the activities sponsored by the Vermont Wilderness School and are beyond the control of the instructors, agents, officers, students, and employees of the Vermont Wilderness School. I understand that participation in any program activities may entail unavoidable risk of personal injury, death, and/or loss or damage to property. 

Furthermore I, the undersigned, accept and understand that I am solely responsible for:

  • providing a computer and/or phone, internet access, and any other costs needed to access this distance-learning program;
  • understanding any and all relevant laws and regulations that apply to activities I may engage in as part of this program (e.g. laws or ordinances prohibiting fires that apply to my location);
  • any and all consequences resulting from actions I take that contradict guidance given by Vermont Wilderness School staff and local or state or federal authorities;
  • any and all necessary communications, resources, and agreements related to interactions with other program participants and the consequences thereof and;
  • providing my own food, water, accommodation, and transportation related to any element of this program.

Knowing there are risks, I hereby assume all risks of injury, illness and disease, and death to me or my child and loss of, or damage to property arising out of my or my child's participation in such activity and I agree to indemnify, hold harmless the Vermont Wilderness School, its officers, instructors, agents and employees from and against all claims arising from any occurrence causing damage or injury to myself or my child or to any party participating in said event or any third parties injured as a result of my or my child's actions. 

I have read and understand the terms and conditions of this Indemnification and Waiver and I agree to subscribe to them.

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.

By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information
Please select the program you're participating in from this list*
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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