Participant Agreement, Release and Assumption of Risk

LAT45° ADVENTURE MINISTRIES PARTICIPANT AGREEMENT, RELEASE AND ASSUMPTION OF RISK

In consideration of the services of Lat45° Adventure Ministries, guides, their agents, owners, officers, principles, volunteers, participants, employees, and all other persons or entities acting in any capacity on their behalf (hereinafter collectively referred to as “Lat45° Adventure Ministries”), I hereby agree to release, indemnify, and discharge Lat45 Adventure Ministries, on behalf of myself, my spouse, my children, my parents, my heirs, assigns, personal representatives and estate as follows:

RELEASE OF LIABILITY AND ASSUMPTION OF RISK

I understand that the Lat45° Adventure Ministries experience, whether a single-day or multiple day trip, may involve activities and group living arrangements and interactions that may be new to me or my child, and that these experiences come with certain risks and uncertainties beyond what I or my child may be used to dealing with at home. I am aware of these risks, and I am assuming them on behalf of myself or my child. I realize that no environment is risk-free, and so I have instructed my child on the importance of abiding by Lat45° Adventure Ministries’ rules, and my child and I both agree that I, he or she will obey Lat45 Adventure Ministries’ rules and the rules of the group’s leaders. I understand that Lat45° Adventure Ministries’ activities occur in diverse terrain and weather conditions and sometimes in remote backcountry areas.

I authorize myself or my son/daughter to participate fully in all of Lat45° Adventure Ministries’ activities. These activities include, but are not limited to backpacking, hiking, biking, canoeing, kayaking, caving, rock climbing, rappelling, swimming, rock/bridge/cliff jumping, mountain biking, mountaineering, show shoeing, snowboarding, snow skiing, camping, snow camping, rafting (including white water and tubing), fly-fishing. All of these are physical activities that involve risk of personal injury, including both emotional and physical injury up to or including paralysis or death; as well as damage to personal property. I understand that Lat45° Adventure Ministries cannot safeguard against all such injuries, and I expressly agree to assume such risk and waive, release, save and hold harmless Lat45° Adventure Ministries, its officers, agents, employees, and any federal, state or local agencies which have jurisdiction over lands or properties upon which Lat45° Adventure Ministries’ programs operate, from any claim of liability, settlement, judgment, award or cost of defense and attorneys’ fees, including negligence, except gross neglect, by Lat45° Adventure Ministries for any loss, damage, or injury incurred during the program(s) for which I or my son/daughter is participating.

I attest that I/my son/daughter has been fully informed of the program activities and agrees to participate. I agree to fully disclose all physical, mental and emotional conditions that could impact the safety or success of the program. I certify that I am willing to assume the risk of any medical condition I or my son/daughter may have. I certify that I have adequate insurance to cover any injury or damage I or my son/daughter may cause or suffer while participating, or else I agree to bear the costs of such injury or damage myself. It is agreed that any dispute or cause of action arising between the parties, whether out of this agreement or otherwise, can only be brought in a court of competent jurisdiction located in Madison County, Montana, and shall be occurred. In addition, I understand and accept the Terms of Agreement as stated in this waiver. If any portion of this agreement is found to be invalid or not enforceable by a court of proper jurisdiction, the remainder of the agreement shall nevertheless remain valid and fully enforceable.

TERMS OF AGREEMENT

Rules and Regulations: Participants will be expected to commit to a verbal contract at the beginning of the program. This contract will include a commitment to guidelines of behavior for the safety and well-being of the individual and group. These include the prohibition of all forms of tobacco, alcohol and illegal drugs, cooperation with group leaders and other members of the group, and the commitment to not become involved in cliques and mutually exclusive one on one relationships and excessive displays of affection. The trip leaders will handle discipline problems in the manner that they see fit, according to industry guidelines. If a participant is dismissed for the well-being of the program or for failure to cooperate, parent/guardian(s) will be called and are responsible to pick up their child immediately and at their own expense. No refund will be given.

Equipment: The parent/guardian is responsible for and agrees to reimbursement for loss of or willful destruction by the participant of any equipment belonging to Lat45° Adventure Ministries. Lat45° Adventure Ministries will not be responsible for any participant’s possessions that are lost or stolen while he/she is on the trip.

Model Release: I authorize and agree to the reasonable and proper use by Lat45° Adventure Ministries of any and all photographs/videos/statements by, of, or about my child.

I acknowledge that this agreement applies to all future events of Lat45° Adventure Ministries (program) until cancelled or replaced in writing.

I have had sufficient opportunity to read this entire document. I have read and understood it, and I agree to be bound by its terms. I certify that the above information is true and accurate to the best of my knowledge.

Today's date: May 3, 2024

Please select who will be participating...

Adult Minor(s)
1 Minor 2 Minors 3 Minors 4 Minors 5 Minors More Minors 6 Minors 7 Minors 8 Minors 9 Minors 10 Minors

Continue

Second Participants Name

First Name*

Last Name*

Second Participants Date of Birth*

Second Participants Information

Age when trip begins *

Date of Trip *

Participant Medical History

Current Height: *

Weight: *

Date of last physical exam: *

Doctor's Name:

Phone Number:

Please list any current health conditions (if none, type none): *

Please explain any significant injuries, including treatment. If none, type none: *

Are there any fears, special needs, or recent events in the participant's life that may impact his/her experience or behavior during outdoor activities? If so, please explain in detail. *

Do you feel that any aspect of the participant's mental or physical health may endanger him/herself, the guides, or other members of the group? Are there any activities that may physically or mentally cause too much exertion or anxiety on the participant? If so, please explain in detail. *

Are there certain situations, conditions, foods, or medications that may trigger a negative reaction in the participant? (if none, type none) *

Does the participant have a history of any of the following medical conditions? *

Fainting Seizures

Panic/Anxiety Attacks

Headaches Stomachaches

Asthmas or other breathing problems

Other

My child has none of these

If Other, please specify:

Please list any medications that the camper will take, and any possible side effects that may occur. *

Please list the date and reason for any hospitalizations and surgeries. *

Does the participant suffer from any form of sleeping disorder (including insomnia or bed wetting)?*

Yes

If yes, please explain and give usual precautions/ treatment:

I certify that the above information is true and accurate according to the best of my knowledge.

Third Participants Name

First Name*

Last Name*

Third Participants Date of Birth*

Third Participants Information

Age when trip begins *

Date of Trip *

Participant Medical History

Current Height: *

Weight: *

Date of last physical exam: *

Doctor's Name:

Phone Number:

Please list any current health conditions (if none, type none): *

Please explain any significant injuries, including treatment. If none, type none: *

Are there any fears, special needs, or recent events in the participant's life that may impact his/her experience or behavior during outdoor activities? If so, please explain in detail. *

Are there certain situations, conditions, foods, or medications that may trigger a negative reaction in the participant? (if none, type none) *

Does the participant have a history of any of the following medical conditions? *

Fainting Seizures

Panic/Anxiety Attacks

Headaches Stomachaches

Asthmas or other breathing problems

Other

My child has none of these

If Other, please specify:

Please list any medications that the camper will take, and any possible side effects that may occur. *

Please list the date and reason for any hospitalizations and surgeries. *

Does the participant suffer from any form of sleeping disorder (including insomnia or bed wetting)?*

Yes

If yes, please explain and give usual precautions/ treatment:

I certify that the above information is true and accurate according to the best of my knowledge.

Fourth Participants Name

First Name*

Last Name*

Fourth Participants Date of Birth*

Fourth Participants Information

Age when trip begins *

Date of Trip *

Participant Medical History

Current Height: *

Weight: *

Date of last physical exam: *

Doctor's Name:

Phone Number:

Please list any current health conditions (if none, type none): *

Please explain any significant injuries, including treatment. If none, type none: *

Are there any fears, special needs, or recent events in the participant's life that may impact his/her experience or behavior during outdoor activities? If so, please explain in detail. *

Are there certain situations, conditions, foods, or medications that may trigger a negative reaction in the participant? (if none, type none) *

Does the participant have a history of any of the following medical conditions? *

Fainting Seizures

Panic/Anxiety Attacks

Headaches Stomachaches

Asthmas or other breathing problems

Other

My child has none of these

If Other, please specify:

Please list any medications that the camper will take, and any possible side effects that may occur. *

Please list the date and reason for any hospitalizations and surgeries. *

Does the participant suffer from any form of sleeping disorder (including insomnia or bed wetting)?*

Yes

If yes, please explain and give usual precautions/ treatment:

I certify that the above information is true and accurate according to the best of my knowledge.

Fifth Participants Name

First Name*

Last Name*

Fifth Participants Date of Birth*

Fifth Participants Information

Age when trip begins *

Date of Trip *

Participant Medical History

Current Height: *

Weight: *

Date of last physical exam: *

Doctor's Name:

Phone Number:

Please list any current health conditions (if none, type none): *

Please explain any significant injuries, including treatment. If none, type none: *

Are there any fears, special needs, or recent events in the participant's life that may impact his/her experience or behavior during outdoor activities? If so, please explain in detail. *

Are there certain situations, conditions, foods, or medications that may trigger a negative reaction in the participant? (if none, type none) *

Does the participant have a history of any of the following medical conditions? *

Fainting Seizures

Panic/Anxiety Attacks

Headaches Stomachaches

Asthmas or other breathing problems

Other

My child has none of these

If Other, please specify:

Please list any medications that the camper will take, and any possible side effects that may occur. *

Please list the date and reason for any hospitalizations and surgeries. *

Does the participant suffer from any form of sleeping disorder (including insomnia or bed wetting)?*

Yes

If yes, please explain and give usual precautions/ treatment:

I certify that the above information is true and accurate according to the best of my knowledge.

Sixth Participants Name

First Name*

Last Name*

Sixth Participants Date of Birth*

Sixth Participants Information

Age when trip begins *

Date of Trip *

Participant Medical History

Current Height: *

Weight: *

Date of last physical exam: *

Doctor's Name:

Phone Number:

Please list any current health conditions (if none, type none): *

Please explain any significant injuries, including treatment. If none, type none: *

Are there any fears, special needs, or recent events in the participant's life that may impact his/her experience or behavior during outdoor activities? If so, please explain in detail. *

Are there certain situations, conditions, foods, or medications that may trigger a negative reaction in the participant? (if none, type none) *

Does the participant have a history of any of the following medical conditions? *

Fainting Seizures

Panic/Anxiety Attacks

Headaches Stomachaches

Asthmas or other breathing problems

Other

My child has none of these

If Other, please specify:

Please list any medications that the camper will take, and any possible side effects that may occur. *

Please list the date and reason for any hospitalizations and surgeries. *

Does the participant suffer from any form of sleeping disorder (including insomnia or bed wetting)?*

Yes

If yes, please explain and give usual precautions/ treatment:

I certify that the above information is true and accurate according to the best of my knowledge.

Seventh Participants Name

First Name*

Last Name*

Seventh Participants Date of Birth*

Seventh Participants Information

Age when trip begins *

Date of Trip *

Participant Medical History

Current Height: *

Weight: *

Date of last physical exam: *

Doctor's Name:

Phone Number:

Please list any current health conditions (if none, type none): *

Please explain any significant injuries, including treatment. If none, type none: *

Are there any fears, special needs, or recent events in the participant's life that may impact his/her experience or behavior during outdoor activities? If so, please explain in detail. *

Are there certain situations, conditions, foods, or medications that may trigger a negative reaction in the participant? (if none, type none) *

Does the participant have a history of any of the following medical conditions? *

Fainting Seizures

Panic/Anxiety Attacks

Headaches Stomachaches

Asthmas or other breathing problems

Other

My child has none of these

If Other, please specify:

Please list any medications that the camper will take, and any possible side effects that may occur. *

Please list the date and reason for any hospitalizations and surgeries. *

Does the participant suffer from any form of sleeping disorder (including insomnia or bed wetting)?*

Yes

If yes, please explain and give usual precautions/ treatment:

I certify that the above information is true and accurate according to the best of my knowledge.

Eighth Participants Name

First Name*

Last Name*

Eighth Participants Date of Birth*

Eighth Participants Information

Age when trip begins *

Date of Trip *

Participant Medical History

Current Height: *

Weight: *

Date of last physical exam: *

Doctor's Name:

Phone Number:

Please list any current health conditions (if none, type none): *

Please explain any significant injuries, including treatment. If none, type none: *

Are there any fears, special needs, or recent events in the participant's life that may impact his/her experience or behavior during outdoor activities? If so, please explain in detail. *

Are there certain situations, conditions, foods, or medications that may trigger a negative reaction in the participant? (if none, type none) *

Does the participant have a history of any of the following medical conditions? *

Fainting Seizures

Panic/Anxiety Attacks

Headaches Stomachaches

Asthmas or other breathing problems

Other

My child has none of these

If Other, please specify:

Please list any medications that the camper will take, and any possible side effects that may occur. *

Please list the date and reason for any hospitalizations and surgeries. *

Does the participant suffer from any form of sleeping disorder (including insomnia or bed wetting)?*

Yes

If yes, please explain and give usual precautions/ treatment:

I certify that the above information is true and accurate according to the best of my knowledge.

Ninth Participants Name

First Name*

Last Name*

Ninth Participants Date of Birth*

Ninth Participants Information

Age when trip begins *

Date of Trip *

Participant Medical History

Current Height: *

Weight: *

Date of last physical exam: *

Doctor's Name:

Phone Number:

Please list any current health conditions (if none, type none): *

Please explain any significant injuries, including treatment. If none, type none: *

Are there any fears, special needs, or recent events in the participant's life that may impact his/her experience or behavior during outdoor activities? If so, please explain in detail. *

Are there certain situations, conditions, foods, or medications that may trigger a negative reaction in the participant? (if none, type none) *

Does the participant have a history of any of the following medical conditions? *

Fainting Seizures

Panic/Anxiety Attacks

Headaches Stomachaches

Asthmas or other breathing problems

Other

My child has none of these

If Other, please specify:

Please list any medications that the camper will take, and any possible side effects that may occur. *

Please list the date and reason for any hospitalizations and surgeries. *

Does the participant suffer from any form of sleeping disorder (including insomnia or bed wetting)?*

Yes

If yes, please explain and give usual precautions/ treatment:

I certify that the above information is true and accurate according to the best of my knowledge.

Tenth Participants Name

First Name*

Last Name*

Tenth Participants Date of Birth*

Tenth Participants Information

Age when trip begins *

Date of Trip *

Participant Medical History

Current Height: *

Weight: *

Date of last physical exam: *

Doctor's Name:

Phone Number:

Please list any current health conditions (if none, type none): *

Please explain any significant injuries, including treatment. If none, type none: *

Are there any fears, special needs, or recent events in the participant's life that may impact his/her experience or behavior during outdoor activities? If so, please explain in detail. *

Are there certain situations, conditions, foods, or medications that may trigger a negative reaction in the participant? (if none, type none) *

Does the participant have a history of any of the following medical conditions? *

Fainting Seizures

Panic/Anxiety Attacks

Headaches Stomachaches

Asthmas or other breathing problems

Other

My child has none of these

If Other, please specify:

Please list any medications that the camper will take, and any possible side effects that may occur. *

Please list the date and reason for any hospitalizations and surgeries. *

Does the participant suffer from any form of sleeping disorder (including insomnia or bed wetting)?*

Yes

If yes, please explain and give usual precautions/ treatment:

I certify that the above information is true and accurate according to the best of my knowledge.

Participants 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:*

Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*

Parent or Guardian's Email Address

Email*

Confirm Email*

Check to receive information about Lat45 and upcoming trips and events by e-mail.

Insurance

Insurance Carrier*

Insurance Policy Number*

Additional Insurance Information:

Group number: *

Insurance Phone Number:

Subscriber's Name: *

Subscriber's Relationship to Patient: *

OR

I do not have medical insurance coverage at this time and assume all responsibility for any medical treatment my child may need.

Additional Information

Name and city of home church if applicable

Name and city of school, or homeschool?

Grade Participant Will Enter in Fall?

What experience does the participant have hiking, backpacking, or being in the outdoors? Have they ever backpacked with Lat45° before?*

None yet

Day Hiking Occasionally

Day Hiking Regularly

Backpacking 1-3 Trips

Backpacking Multiple Times

Lat45° Backpacking Alumni!

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.

Agree To This Document

Smartwaiver - TRY IT FREE!