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Adventure Crew Waiver Liability Form

1. THE UNDERSIGNED HEREBY GRANTS PERMISSION for my son/daughter/ward to participate in Adventure Crew field trips. I understand these field trips are optional and attendance by said child is not required. Transportation for these activities varies and I am aware of and consent to the plans.

2. THE UNDERSIGNED UNDERSTANDS AND AGREES that the above named student will be responsible in conduct to all adult supervisors at all times. It is further understood students’ images/words may be recorded and used in Adventure Crew promotion.

3. THE UNDERSIGNED HEREBY RELEASES, WAIVES, DISCHARGES AND COVENANTS NOT TO SUE Adventure Crew, its directors, officers, employees, and agents (hereinafter referred to as “releasees”) from all liability to the undersigned, his personal representatives, assigns, heirs, and next of kin for any loss or damage, and any claim or demands therefore on account of injury to the person or property or resulting in death of the undersigned, whether caused by the negligence of the releasees or otherwise while the undersigned is in, upon, or about the premises or any facilities or equipment therein, or participating in any program affiliated with Adventure Crew, without respect to location.

4. THE UNDERSIGNED HEREBY AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS the releasees and each of them from any loss, liability, damage, or cost they may incur due to the presence of the undersigned in, upon, or about the Adventure Crew premises or in any way observing or using any facilities or equipment of the Adventure Crew or participating in any program affiliated regardless of location, with Adventure Crew whether caused by the negligence of the releases or otherwise.

5. THE UNDERSIGNED HEREBY ASSUMES FULL RESPONSIBILITY FOR ANY RISK OF BODILY INJURY, DEATH, OR PROPERTY DAMAGE due to negligence of releasees or otherwise while in, about, or upon the premises of Adventure Crew and/or while using the premises or any facilities or equipment thereon or participating in any program affiliated with Adventure Crew.

6. THE UNDERSIGNED HEREBY DECLARES that all the information on the Medical Emergency Form is correct and representative of the person herein described, and further agrees to give full authority to the health care personnel selected by Adventure Crew to administer medications; provide routine health care, photocopy forms, and to order: X-Rays, routine tests; treatment; transportation; and hospitalization should the need arise.

7. THE UNDERSIGNED HEREBY RELEASES, WAIVES, DISCHARGES, AND COVENANTS NOT TO SUE RELEASEES FROM LIABILITY from any claim whatsoever which may result of any first aid, treatment, services, or assistance to the person while in, about, or upon the premises or any facilities or equipment thereon or participating in any program affiliated with Adventure Crew.

8. THE UNDERSIGNED further expressly agrees that foregoing RELEASE, WAIVER AND INDEMNITY AGREEMENT is intended to be as broad and inclusive as is permitted by the law of the State and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

9. THE UNDERSIGNED HAS READ AND VOLUNTARILY SIGNS THE RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT, and further agrees that no oral representations, statements, or inducements apart from the foregoing written agreement have been made.

Date: October 22, 2025

First Participant's Name
First Name*
Middle Name
Last Name*
Phone*
First Participant's Date of Birth*
Date of Birth
First Participant's Information
Nickname (optional):
School Attended*
Grade*
Student email: *
Age: *
Gender*
Pronouns *
he/him
she/her
they/them
ze/zir
Prefer not to say
Race/ethnicity (select all that apply) *
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino/a/e/x
Middle Eastern or North African
Native Hawaiian or Other Pacific Islander
White or Caucasian
Prefer not to say

Physician/Insurance Information

Primary Care Physician’s Name:
Phone:
Health Insurance Company:
Policy Number:
Policy Holder’s Name:
Relationship to Participant:

Medications/Medical Conditions


Current Medications:
Can participant take over-the-counter medications? *
No
Yes
Exception:
Are immunizations up to date? *
No
Yes
Date of Last Tetanus Shot:

Allergies of which we should be aware?

Please explain any other medical conditions of which we should be aware?
First Participant's Signature*
Second Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Second Participant's Information
Nickname (optional):
School Attended*
Grade*
Student email: *
Age: *
Gender*
Pronouns *
he/him
she/her
they/them
ze/zir
Prefer not to say
Race/ethnicity (select all that apply) *
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino/a/e/x
Middle Eastern or North African
Native Hawaiian or Other Pacific Islander
White or Caucasian
Prefer not to say

Physician/Insurance Information

Primary Care Physician’s Name:
Phone:
Health Insurance Company:
Policy Number:
Policy Holder’s Name:
Relationship to Participant:

Medications/Medical Conditions


Current Medications:
Can participant take over-the-counter medications? *
No
Yes
Exception:
Are immunizations up to date? *
No
Yes
Date of Last Tetanus Shot:

Allergies of which we should be aware?

Please explain any other medical conditions of which we should be aware?
Third Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Third Participant's Information
Nickname (optional):
School Attended*
Grade*
Student email: *
Age: *
Gender*
Pronouns *
he/him
she/her
they/them
ze/zir
Prefer not to say
Race/ethnicity (select all that apply) *
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino/a/e/x
Middle Eastern or North African
Native Hawaiian or Other Pacific Islander
White or Caucasian
Prefer not to say

Physician/Insurance Information

Primary Care Physician’s Name:
Phone:
Health Insurance Company:
Policy Number:
Policy Holder’s Name:
Relationship to Participant:

Medications/Medical Conditions


Current Medications:
Can participant take over-the-counter medications? *
No
Yes
Exception:
Are immunizations up to date? *
No
Yes
Date of Last Tetanus Shot:

Allergies of which we should be aware?

Please explain any other medical conditions of which we should be aware?
Fourth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Fourth Participant's Information
Nickname (optional):
School Attended*
Grade*
Student email: *
Age: *
Gender*
Pronouns *
he/him
she/her
they/them
ze/zir
Prefer not to say
Race/ethnicity (select all that apply) *
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino/a/e/x
Middle Eastern or North African
Native Hawaiian or Other Pacific Islander
White or Caucasian
Prefer not to say

Physician/Insurance Information

Primary Care Physician’s Name:
Phone:
Health Insurance Company:
Policy Number:
Policy Holder’s Name:
Relationship to Participant:

Medications/Medical Conditions


Current Medications:
Can participant take over-the-counter medications? *
No
Yes
Exception:
Are immunizations up to date? *
No
Yes
Date of Last Tetanus Shot:

Allergies of which we should be aware?

Please explain any other medical conditions of which we should be aware?
Fifth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Fifth Participant's Information
Nickname (optional):
School Attended*
Grade*
Student email: *
Age: *
Gender*
Pronouns *
he/him
she/her
they/them
ze/zir
Prefer not to say
Race/ethnicity (select all that apply) *
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino/a/e/x
Middle Eastern or North African
Native Hawaiian or Other Pacific Islander
White or Caucasian
Prefer not to say

Physician/Insurance Information

Primary Care Physician’s Name:
Phone:
Health Insurance Company:
Policy Number:
Policy Holder’s Name:
Relationship to Participant:

Medications/Medical Conditions


Current Medications:
Can participant take over-the-counter medications? *
No
Yes
Exception:
Are immunizations up to date? *
No
Yes
Date of Last Tetanus Shot:

Allergies of which we should be aware?

Please explain any other medical conditions of which we should be aware?
Sixth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Sixth Participant's Information
Nickname (optional):
School Attended*
Grade*
Student email: *
Age: *
Gender*
Pronouns *
he/him
she/her
they/them
ze/zir
Prefer not to say
Race/ethnicity (select all that apply) *
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino/a/e/x
Middle Eastern or North African
Native Hawaiian or Other Pacific Islander
White or Caucasian
Prefer not to say

Physician/Insurance Information

Primary Care Physician’s Name:
Phone:
Health Insurance Company:
Policy Number:
Policy Holder’s Name:
Relationship to Participant:

Medications/Medical Conditions


Current Medications:
Can participant take over-the-counter medications? *
No
Yes
Exception:
Are immunizations up to date? *
No
Yes
Date of Last Tetanus Shot:

Allergies of which we should be aware?

Please explain any other medical conditions of which we should be aware?
Seventh Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Seventh Participant's Information
Nickname (optional):
School Attended*
Grade*
Student email: *
Age: *
Gender*
Pronouns *
he/him
she/her
they/them
ze/zir
Prefer not to say
Race/ethnicity (select all that apply) *
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino/a/e/x
Middle Eastern or North African
Native Hawaiian or Other Pacific Islander
White or Caucasian
Prefer not to say

Physician/Insurance Information

Primary Care Physician’s Name:
Phone:
Health Insurance Company:
Policy Number:
Policy Holder’s Name:
Relationship to Participant:

Medications/Medical Conditions


Current Medications:
Can participant take over-the-counter medications? *
No
Yes
Exception:
Are immunizations up to date? *
No
Yes
Date of Last Tetanus Shot:

Allergies of which we should be aware?

Please explain any other medical conditions of which we should be aware?
Eighth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Eighth Participant's Information
Nickname (optional):
School Attended*
Grade*
Student email: *
Age: *
Gender*
Pronouns *
he/him
she/her
they/them
ze/zir
Prefer not to say
Race/ethnicity (select all that apply) *
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino/a/e/x
Middle Eastern or North African
Native Hawaiian or Other Pacific Islander
White or Caucasian
Prefer not to say

Physician/Insurance Information

Primary Care Physician’s Name:
Phone:
Health Insurance Company:
Policy Number:
Policy Holder’s Name:
Relationship to Participant:

Medications/Medical Conditions


Current Medications:
Can participant take over-the-counter medications? *
No
Yes
Exception:
Are immunizations up to date? *
No
Yes
Date of Last Tetanus Shot:

Allergies of which we should be aware?

Please explain any other medical conditions of which we should be aware?
Ninth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Ninth Participant's Information
Nickname (optional):
School Attended*
Grade*
Student email: *
Age: *
Gender*
Pronouns *
he/him
she/her
they/them
ze/zir
Prefer not to say
Race/ethnicity (select all that apply) *
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino/a/e/x
Middle Eastern or North African
Native Hawaiian or Other Pacific Islander
White or Caucasian
Prefer not to say

Physician/Insurance Information

Primary Care Physician’s Name:
Phone:
Health Insurance Company:
Policy Number:
Policy Holder’s Name:
Relationship to Participant:

Medications/Medical Conditions


Current Medications:
Can participant take over-the-counter medications? *
No
Yes
Exception:
Are immunizations up to date? *
No
Yes
Date of Last Tetanus Shot:

Allergies of which we should be aware?

Please explain any other medical conditions of which we should be aware?
Tenth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Tenth Participant's Information
Nickname (optional):
School Attended*
Grade*
Student email: *
Age: *
Gender*
Pronouns *
he/him
she/her
they/them
ze/zir
Prefer not to say
Race/ethnicity (select all that apply) *
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino/a/e/x
Middle Eastern or North African
Native Hawaiian or Other Pacific Islander
White or Caucasian
Prefer not to say

Physician/Insurance Information

Primary Care Physician’s Name:
Phone:
Health Insurance Company:
Policy Number:
Policy Holder’s Name:
Relationship to Participant:

Medications/Medical Conditions


Current Medications:
Can participant take over-the-counter medications? *
No
Yes
Exception:
Are immunizations up to date? *
No
Yes
Date of Last Tetanus Shot:

Allergies of which we should be aware?

Please explain any other medical conditions of which we should be aware?
Parent or Guardian's Email Address
Email*
Confirm Email*
Check to receive information, news, and discounts by e-mail.
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(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*
Middle Name
Last Name*
Relationship*
Phone*
Parent or Guardian's Date of Birth*
Date of Birth
Parent or Guardian's Information
Nickname (optional):
School Attended*
Grade*
Student email: *
Age: *
Gender*
Pronouns *
he/him
she/her
they/them
ze/zir
Prefer not to say
Race/ethnicity (select all that apply) *
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino/a/e/x
Middle Eastern or North African
Native Hawaiian or Other Pacific Islander
White or Caucasian
Prefer not to say

Physician/Insurance Information

Primary Care Physician’s Name:
Phone:
Health Insurance Company:
Policy Number:
Policy Holder’s Name:
Relationship to Participant:

Medications/Medical Conditions


Current Medications:
Can participant take over-the-counter medications? *
No
Yes
Exception:
Are immunizations up to date? *
No
Yes
Date of Last Tetanus Shot:

Allergies of which we should be aware?

Please explain any other medical conditions of which we should be aware?
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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