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ACKNOWLEDGEMENT AND ASSUMPTION OF RISK

1) RISKS INHERENT TO THE ACTIVITY
I acknowledge having been informed of the inherent risks pertaining to the activities that are part of the Ski Chic-Chocs
Inc. program.
The risks involved in the activity of descent, guided travel and/or trainings to which I will participate in are the following in a
more practical manner, but non-limitating to these: 

  • Injuries due to avalanches, rock fall, ice fall or snow cornices.
  • Injuries due to trees, tree wells and tree stumps.
  • Injuries due to deficient bindings with or without automatic triggering
  • Injuries due to falls or other movements, (sprain, strain, fracture, death, etc.);
  • Difficult or changing weather and/or temperature
  • Injuries with blunt or sharp object (branches, material, etc.);
  • Injuries due to travel on highways and backcountry roads, snowcat roads and road banks, fences, and other man-made structures;
  • Cold or hypothermia;
  • Injuries resulting from accidental or other contact between individuals;
  • Food allergies;
  • Contact with water or drowning (near a watercourse);
  • Burns and/or other heat induced injuries;

2) AUTHORIZATION TO INTERVENE IN CASE OF EMERGENCY
I, undersigned, authorize Ski Chic-Chocs Inc. to provide all necessary care. I also authorize Ski Chic-Chocs Inc. to take the decision in case of an accident to transport me (by ambulance, helicopter, coast guard or other) to a hospital or health care center, and this, at my own expense.

3) MATERIAL LIABILITY WAIVER
I undersigned, forego to any claim, proceeding in damage or interest to assets and material of my belonging (attrition, loss, breakage, theft, vandalism).

4) PHOTO/VIDEO AND IMAGES WAIVER
I undersigned, forego to any claim, for images taken by Ski Chic-Chocs Inc. or others for promotional use.

5) ALCOHOL AND DRUG POLICY
Please note that it is not allowed to consume, to have in your possession or to be under the infuence of any drugs, legal or otherwise (whether prescribed or not) that is not mentioned on the acknowledgment of risks form. Equally not to have consumed any alcohol: zero tolerance. Any shortcomings to these rules will lead to an immediate expulsion with no prior warnings, this without any possibility of a refund.

6) CONSENT TOWARDS SECURITY MEASURES
I undersigned, consent to obey all security guidelines dictated by Ski Chic-Chocs Inc. The guide reserves the right to exclude anyone that he judges to represent a risk either to themselves or others in the group. I understand that it is possible to exclude myself from the group and leave the activity for any motive.

7) CONFIRMATION OF INFORMATION AND ASSUMPTION OF RISKS
I hereby certify that the information consigned to this form is, to the best of my knowledge, exact and accurate. I further certify that no information pertinent or not to my health profle was deliberately omitted. I am aware that the information contained in this form is confdential and will be used to better plan and supervise the safety of the activities in which I will participate and will allow Ski Chic-Chocs Inc. to draw up a profle of its clientele. I am also aware that the activities offered by Ski Chic-Chocs Inc. take place in semi-wild or natural environments that, consequently, are quite distant from medical services. This state of affairs could result in long delays during an emergency requiring an evacuation and, as such, a possible aggravation of my state of health or my injury. Having taken cognizance of these risks and having had the opportunity to discuss them with a person responsible for the activity, I acknowledge that I was informed about the risks inherent to the activities and I am able to participate in the activity or the stay WILLINGLY AND I ACCEPT ANY AND ALL RISKS THAT such an activity or stay can comprise. I also pledge to play an active role in risk management by adopting a preventive behaviour with regards to my own safety, and the safety of the other persons that surround me. The guide reserves the right to exclude any person he/she deems to be a risk to himself/herself or to the rest of the group. I understand that I may leave the present activity for any reason whatsoever.

8) SELF HEALTH SCREENING AND HEALTH SAFETY POLICY
I understand the signs and symptoms of COVID-19 as they are maintained current by public health and I will not partake in any Ski Chic-Chocs activity is I have any signs or symptoms of the disease or if I have been in close contact with a person who is deemed infectuous. If I begin to show signs or symptoms of this disease I will self isolate, call public health and then contact Ski Chic-Chocs. I have read and understood Ski Chic-Chocs' health safety measures concerning COVID-19 as posted on their website and I agree to comply with all these health safety protocols including maintaining physical distancing of at least 2 meters, wearing the appropriate mask and frequent hand sanitisation. 

May 8, 2021

 

 

Please select who will be participating...
AdultMinor
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First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's HEALTH PROFILE
Allergies?*
Yes
No

If yes, please specify:
Do you take any medication?*
Yes
No

If yes, please specify:

Medication name(s) and dosage:
Do you have physical, emotional or behavioural problems that could limit your participation in your chosen activity? Specify (ex. respiratory, cardiac problems, diabetes, vision or hearing problems, fear of water/heights/dogs, limitation of movements, etc.)*
Yes
No

If yes, please specify:

NB: If you answered YES to any of the questions in section HEALTH PROFILE, YOU HAVE TO NOTIFY THE GUIDE BEFOREHAND.

Having discussed my medical condition with a person in charge at Ski Chic-Chocs Inc., I agree and accept the additional risks that my health condition may be aggravated by participating in the activity.


First Participant's Signature*
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*
I am interested in receiving information about backcountry events, trainings and activities through Ski Chic-Chocs newsletter (less than once a month from September to April)
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 16 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*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's HEALTH PROFILE
Allergies?*
Yes
No

If yes, please specify:
Do you take any medication?*
Yes
No

If yes, please specify:

Medication name(s) and dosage:
Do you have physical, emotional or behavioural problems that could limit your participation in your chosen activity? Specify (ex. respiratory, cardiac problems, diabetes, vision or hearing problems, fear of water/heights/dogs, limitation of movements, etc.)*
Yes
No

If yes, please specify:

NB: If you answered YES to any of the questions in section HEALTH PROFILE, YOU HAVE TO NOTIFY THE GUIDE BEFOREHAND.

Having discussed my medical condition with a person in charge at Ski Chic-Chocs Inc., I agree and accept the additional risks that my health condition may be aggravated by participating in the activity.


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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