Loading...

ACCEPTANCE OF RISK, RELEASE OF LIABILITY FOR NEGLIGENCE, WAIVER OF CLAIMS, EXPRESS ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT

This form must be read, acknowledged, and signed by all Participants, adults and minors (persons under 18 years of age), AND by a parent or court-assigned, legal guardian (each referred to as “Parent”) of a minor Participant. Parent signs for himself or herself and on behalf of the minor child. No applicant may participate in any service or tour unless this form is read and acknowledged by signature of the Participant and/or Participant’s Parent. The parties to this agreement are Spomer Industries LLC DBA Captain Zipline (“Provider”) and the persons signing below (“Participant” and “Parent”).

I. Express Assumption of Risk Associated with Zip Lining

I am aware that Provider offers RECREATIONAL services and tours. My participation and/or my child’s participation in Provider’s services, including but not limited to ziplining, aerial trekking, via ferrata, climbing, hiking (“Tours”), involves RECREATIONAL activities including, but not limited to: traversing uphill slopes and uneven terrain; walking, standing on, scrambling over, or climbing on loose gravel, rock and uneven terrain; climbing; standing or walking near unguarded slopes and steep cliffs; swinging with the use of cables, harnesses, and ropes at heights up to 200 feet above the ground; moving and landing at high speeds with the use of cables, ropes, and harnesses; and traveling by vehicle on paved roads and on unpaved rough, dirt roads to and from the premises of Provider, either in my vehicle or in a vehicle provided by Provider.  I AM/WE ARE AWARE THAT THESE ACTIVITIES MAY BE DANGEROUS, AND THAT PARTICIPATION IN THESE DANGEROUS ACTIVITIES CAN RESULT IN PROPERTY DAMAGE, SERIOUS INJURY, OR DEATH. IF SIGNING AS A PARENT, I HAVE INFORMED MY MINOR CHILD OF THESE RISKS.

I have been informed of the inherent hazards and risks associated with my participation and/or my child’s participation in Provider’s Tours, which can include, in rare cases, serious injury or death. These hazards and risks include, but are not limited to the following: 

Read carefully. After reading, Participant shall sign in the place provided below.

Equipment used by me or others could fail or malfunction

I could fall while walking, standing, traversing challenge elements or ziplines, scrambling on loose terrain, climbing, or using ziplining, aerial trekking, or via ferrata equipment

My clothing, hair, or hands could become caught in zipline, aerial trekking, or via ferrata equipment, obstacles, ropes, or cables; I could injure my hands by grabbing cable, ropes, rock features, or challenge obstacles

While using zipline, aerial trekking, climbing, or via ferrata equipment, I could suffer injuries while traversing obstacles or ziplines by colliding with the ground, a support column, objects, another participant, or a Guide, or in some other fashion

This activity takes place outdoors, and therefore I will be exposed to risks associated with exposure to elements, including sun, wind, rain, or snow, lightning, excessive heat, hypothermia, and encountering objects either natural or human-made, including but not limited to loose, uneven or slippery rock, falling rock or debris, trees, and plants

As a result of my own negligence, or the negligence of Provider and Provider’s employees, agents, or assigns (“Agents”), or of other participants, I may fall, collide with others or objects, and/or suffer serious injury or death

Provider and its Agents may negligently misjudge weather or terrain, or the expertise or comfort level of participants; Provider and its Agents may improperly or negligently use, adjust, or check harnesses, cables, ropes, lanyards, connectors, belay devices, or other equipment; Provider and its Agents may improperly or negligently fail to provide adequate supervision of participants, or adequate training for participants; Provider and its Agents may improperly or negligently operate a motor vehicle in which I am an occupant

I will travel on paved roads and on rough, unpaved dirt roads to and from the premises of Provider, in my own vehicle or in a vehicle owned or leased by Provider

I may encounter adverse plants, insects, reptiles, birds, deer, and other animals

While participating in Provider’s Tours, I will be in a remote location where there are no available medical facilities and where medical attention may be more than one hour away

I or others may suffer from dehydration, heat, fatigue, chill, and/or dizziness, which may diminish my/our reaction time and increase the risk of accident, injury or loss.

I understand the description of these hazards risks is not complete, and that unknown or unanticipated hazards or risks may result in injury, illness, or death.

II. Release of Liability for Negligence, Waiver of Claims, and Indemnity Agreement

In consideration for being permitted to participate in the activities described above and related activities and/or use of its facilities, I/we the undersigned Participant(s), and the Parent of a minor Participant (for himself or herself and on behalf of the minor Participant), agree as follows:

1. I HEREBY RELEASE AND HOLD HARMLESS WITH RESPECT TO ANY AND ALL PROPERTY DAMAGE, INJURY, DISABILITY, DEATH, WHETHER CAUSED BY NEGLIGENCE OR OTHERWISE, the following named persons or entities, herein referred to as “Releasees” or “Released Parties”: Provider and its owners/members, employees, subcontractors, Agents, and assigns;

2. I understand that Provider’s Agents will accompany me while I participate in Tours and will direct and assist me and other participants in our activities. I further understand that Provider’s Agents may not be employees or contractors of Provider. I HEREBY RELEASE PROVIDER ITS AGENTS AND OTHER RELEASEES, AND HOLD THEM HARMLESS FROM ANY AND ALL LIABILITY OF ANY KIND FOR PROPERTY DAMAGE, INJURY, OR DEATH arising from my participation in Tours, whether caused by NEGLIGENCE OR OTHERWISE;

3. I accept full and complete responsibility for any expenses that may be incurred by Provider for any illness or injury that may result from my participation in Provider’s Tours and services, including the costs of evacuation, hospitalization, and medical treatment and any sums payable to anyone by reason of any injury or loss of life that I may sustain through my participation in Provider’s Tours or services, and for all expenses associated with the defense of any such claims.

4. I, on behalf of myself and my estate, heirs, successors, survivors, assigns, guardians, agents, and personal representatives, hereby agree and warrant that: a) I waive any and all claims against the Provider, its Agents and other Releasees; b) I will not sue or assert any claim or cause of action, whether before a court of law or otherwise, against Provider, its Agents, and other Releasees; c) I will defend, indemnify, and hold harmless Provider, its Agents, and other Releasees for injuries, death, or property damage caused by or related to my participation in Tours whether caused by active or passive negligence of Provider, its Agents or other Releasees or otherwise; d) if I take legal or other action that is contrary to the terms of this Agreement, I will be responsible for the payment of all attorney fees and costs incurred by Provider, its Agents, and other Releasees; e) I agree that if I bring legal action of any kind arising out of my participation in Tours, I will bring such legal action only in courts in the State of Colorado. I agree that Colorado courts shall have exclusive jurisdiction over any such legal action, and I hereby waive my right to bring any such legal action in courts or bodies in any other state or jurisdiction.

III. Photographic, Video, and Media Release of Participant Likeness

Provider, its Agents, and other Releases reserve the right to use audio, video, or other photographic images of or by Participant for future marketing, educational or other purposes, and Participant/Parent hereby consent to such use, without compensation.

IV. Other

By entering into this Agreement, I am not relying on any oral or written representation or statements made by Provider, its Agents, or other Releasees, other than what is set forth in this Agreement.

This release shall be binding to the fullest extent permitted by law. If any provision of this release is found to be unenforceable, the remaining terms shall be enforceable.

I HAVE READ THIS RELEASE OF LIABILITY FOR NEGLIGENCE, WAIVER OF CLAIMS, EXPRESS ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT, AND I FULLY UNDERSTAND ITS TERMS. I UNDERSTAND THAT I HAVE GIVEN UP LEGAL RIGHTS BY SIGNING IT, AND I SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

Today's date: December 21, 2024


First Participant's Name

First Name*

Last Name*
First Participant's Date of Birth*
First Participant's Information
Do you have any health issues that may affect your ability to participate in Provider tours?*
No
Yes

If yes, please explain:
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information
Do you have any health issues that may affect your ability to participate in Provider tours?*
No
Yes

If yes, please explain:
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information
Do you have any health issues that may affect your ability to participate in Provider tours?*
No
Yes

If yes, please explain:
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information
Do you have any health issues that may affect your ability to participate in Provider tours?*
No
Yes

If yes, please explain:
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information
Do you have any health issues that may affect your ability to participate in Provider tours?*
No
Yes

If yes, please explain:
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information
Do you have any health issues that may affect your ability to participate in Provider tours?*
No
Yes

If yes, please explain:
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information
Do you have any health issues that may affect your ability to participate in Provider tours?*
No
Yes

If yes, please explain:
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information
Do you have any health issues that may affect your ability to participate in Provider tours?*
No
Yes

If yes, please explain:
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information
Do you have any health issues that may affect your ability to participate in Provider tours?*
No
Yes

If yes, please explain:
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information
Do you have any health issues that may affect your ability to participate in Provider tours?*
No
Yes

If yes, please explain:
Parent or Guardian's Email Address

Email*

Confirm Email*
I hereby certify that I am the parent or legal guardian of the minor child whose name appears on this Acceptance of Risk, Release of Liability for Negligence, Waiver of Claims, Express Assumption of Risk, and Indemnity Agreement (“Agreement”). I have acknowledged receipt of the Agreement, been given the opportunity to review the Agreement, read its contents, and am satisfied with, and in agreement with, the contents therein, having had the opportunity to discuss the same with the Provider and any third parties of my choosing. I, individually and as parent and/or legal guardian of my minor child do freely accept the terms of Agreement. I give my child permission to participate in the activities and services to be provided by Provider. My signature below reflects my agreement to fully release the Releasees, as provided above, from any claim which I may have, and to release such persons on behalf of my child, for any claim the child may have. I further agree to indemnify the Releasees for any claims of the child, or of any member of my or the child’s family, arising from the child’s enrollment or participation of the activities of the Provider. These agreements of release and indemnity include claims of negligence of a Releasees, including the negligence of any person or entity for whom a Releasees may be vicariously liable.


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*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information
Do you have any health issues that may affect your ability to participate in Provider tours?*
No
Yes

If yes, please explain:
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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!