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RELEASE OF LIABILITY, ASSUMPTION OF RISK, WAIVER OF CLAIMS & INDEMNIFICATION AGREEMENT

Release of Liability; Assumption of Risk; Waiver of Claims; and Indemnification Agreement

 

In consideration of being allowed to use the facilities and participate in Crossnore's aerial adventure, climbing wall and low ropes elements and other activities (collectively the “Activities”) provided by Crossnore Communities for Children​ (the “Host”), the Participant, and the Participant’s parent(s) or legal guardian(s) if the Participant is a minor, do hereby agree, to the fullest extent permitted by law, as follows:


  1. ​TO WAIVE ALL CLAIMS​ that they have or may have against the Host arising out of the Participant’s participation in the Activities or the use of any equipment provided by the Host (“Equipment”), including while receiving instruction and/or training;


  1. ​TO ASSUME ALL RISKS​ of participating in the Activities and using the Equipment, even those caused by the negligent acts or conduct of the Host, its owners, affiliates, operators, employees, agents, and/or officers. The Participant and his/her parent(s) or legal guardian(s) understand that there are inherent risks of participating in the Activities and using the Equipment, which may be both foreseen and unforeseen and include serious physical injury and death;


  1. ​TO RELEASE​ the Host, its owners, affiliates, operators, employees, agents, and officers from all liability for any loss, damage, injury, death, or expense that the Participant (or his/her next of kin) may suffer, arising out of his/her participation in the Activities and/or use of the Equipment, including while receiving instruction and/or training. The Participant and his/her parent(s) or legal guardian(s) specifically understand that they are releasing any and all claims that arise or may arise from any ​negligent​ acts or conduct of the Host, its owners, affiliates, operators, employees, agents, and/or officers, to the fullest extent permitted by law. However, nothing in this Agreement shall be construed as a release for conduct that is found to constitute gross negligence or intentional conduct; and


  1. ​TO INDEMNIFY​ the Host, its owners, affiliates, operators, employees, agents, and/or officers, from all liability for any loss, damage, injury, death, or expense that the Participant (or his/her next of kin) may suffer, arising out of participation in the Activities and/or use of the Equipment, including while receiving instruction and/or training. 

 

Photography/Video Release


Participant hereby understands that photographs and videos may be taken by the Host, its representatives, and employees in connection with Participant’s participation in the Activities. Permission will be sought by participant and/or legal guardian if Host wishes to use photographs and/or videos of Participant for any lawful purpose, including but not limited to publicity, illustration, advertising, and Web content.

 

Personal Responsibility


I certify that I am aware of the weight (less than 300 pounds), age (at least 4 years old), and medical restrictions applicable to the Activit(ies) in which I am participating and confirm that I meet each of those requirements and am in reasonably good medical condition. I understand that failure to abide by these restrictions can create a significant increase of risk of harm to myself, other participants, and Crossnore employees. 


The Participant and his/her parent(s) or legal guardian(s) understand that Participant’s participation in the Activities is voluntary and further understand that they have the opportunity to inspect the Host’s Equipment and facilities before any participation.


The Participant and his/her parent(s) or legal guardian(s) understand that Participant is obligated to follow the rules of the Activities and that he/she can minimize his/her risk of injury by doing so and through the exercise of common sense and by being aware of his/her surroundings.


If, while participating in the Activities, the Participant or his/her parent(s) or legal guardian(s) observe any unusual hazard or condition, which they believe jeopardizes Participant’s personal safety or that of others, Participant and/or his/her parent(s) or legal guardian(s) will remove Participant from participation in the Activities and immediately bring said hazard or condition to the attention of the Host.


Activities follow the “challenge by choice” philosophy, and as such allow The Participant to engage in elements of the experience under his/her volition and The Participant will not be coerced/forced into completing any Activities and in some instances alternative Activities can be used to accomplish the same goals.


To the extent that any portion of this Agreement is deemed to be invalid under the law of the applicable jurisdiction, the remaining portions of the Agreement shall remain binding and available for use by the Host and its counsel in any proceeding.



First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information
Do you have any pre-existing injuries (ankle, back, knees, etc.) that might be aggravated by the activities?*

If Yes, please specify:
Do you have any allergies?*

If Yes, please specify:
Do you carry an Epi-Pen, inhaler, or similar device? If yes, please bring these medications with you. Your medication will be kept secure and readily accessible. If yes and you do not have it available, you are participating in the Activities at your own risk.*
If yes, I authorize Crossnore Staff to administer my medication, if necessary.
Do you have any other ability or health needs we should be aware of today?*

If Yes, please specify:
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 pre-existing injuries (ankle, back, knees, etc.) that might be aggravated by the activities?*

If Yes, please specify:
Do you have any allergies?*

If Yes, please specify:
Do you carry an Epi-Pen, inhaler, or similar device? If yes, please bring these medications with you. Your medication will be kept secure and readily accessible. If yes and you do not have it available, you are participating in the Activities at your own risk.*
If yes, I authorize Crossnore Staff to administer my medication, if necessary.
Do you have any other ability or health needs we should be aware of today?*

If Yes, please specify:
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information
Do you have any pre-existing injuries (ankle, back, knees, etc.) that might be aggravated by the activities?*

If Yes, please specify:
Do you have any allergies?*

If Yes, please specify:
Do you carry an Epi-Pen, inhaler, or similar device? If yes, please bring these medications with you. Your medication will be kept secure and readily accessible. If yes and you do not have it available, you are participating in the Activities at your own risk.*
If yes, I authorize Crossnore Staff to administer my medication, if necessary.
Do you have any other ability or health needs we should be aware of today?*

If Yes, please specify:
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information
Do you have any pre-existing injuries (ankle, back, knees, etc.) that might be aggravated by the activities?*

If Yes, please specify:
Do you have any allergies?*

If Yes, please specify:
Do you carry an Epi-Pen, inhaler, or similar device? If yes, please bring these medications with you. Your medication will be kept secure and readily accessible. If yes and you do not have it available, you are participating in the Activities at your own risk.*
If yes, I authorize Crossnore Staff to administer my medication, if necessary.
Do you have any other ability or health needs we should be aware of today?*

If Yes, please specify:
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information
Do you have any pre-existing injuries (ankle, back, knees, etc.) that might be aggravated by the activities?*

If Yes, please specify:
Do you have any allergies?*

If Yes, please specify:
Do you carry an Epi-Pen, inhaler, or similar device? If yes, please bring these medications with you. Your medication will be kept secure and readily accessible. If yes and you do not have it available, you are participating in the Activities at your own risk.*
If yes, I authorize Crossnore Staff to administer my medication, if necessary.
Do you have any other ability or health needs we should be aware of today?*

If Yes, please specify:
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information
Do you have any pre-existing injuries (ankle, back, knees, etc.) that might be aggravated by the activities?*

If Yes, please specify:
Do you have any allergies?*

If Yes, please specify:
Do you carry an Epi-Pen, inhaler, or similar device? If yes, please bring these medications with you. Your medication will be kept secure and readily accessible. If yes and you do not have it available, you are participating in the Activities at your own risk.*
If yes, I authorize Crossnore Staff to administer my medication, if necessary.
Do you have any other ability or health needs we should be aware of today?*

If Yes, please specify:
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information
Do you have any pre-existing injuries (ankle, back, knees, etc.) that might be aggravated by the activities?*

If Yes, please specify:
Do you have any allergies?*

If Yes, please specify:
Do you carry an Epi-Pen, inhaler, or similar device? If yes, please bring these medications with you. Your medication will be kept secure and readily accessible. If yes and you do not have it available, you are participating in the Activities at your own risk.*
If yes, I authorize Crossnore Staff to administer my medication, if necessary.
Do you have any other ability or health needs we should be aware of today?*

If Yes, please specify:
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information
Do you have any pre-existing injuries (ankle, back, knees, etc.) that might be aggravated by the activities?*

If Yes, please specify:
Do you have any allergies?*

If Yes, please specify:
Do you carry an Epi-Pen, inhaler, or similar device? If yes, please bring these medications with you. Your medication will be kept secure and readily accessible. If yes and you do not have it available, you are participating in the Activities at your own risk.*
If yes, I authorize Crossnore Staff to administer my medication, if necessary.
Do you have any other ability or health needs we should be aware of today?*

If Yes, please specify:
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information
Do you have any pre-existing injuries (ankle, back, knees, etc.) that might be aggravated by the activities?*

If Yes, please specify:
Do you have any allergies?*

If Yes, please specify:
Do you carry an Epi-Pen, inhaler, or similar device? If yes, please bring these medications with you. Your medication will be kept secure and readily accessible. If yes and you do not have it available, you are participating in the Activities at your own risk.*
If yes, I authorize Crossnore Staff to administer my medication, if necessary.
Do you have any other ability or health needs we should be aware of today?*

If Yes, please specify:
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information
Do you have any pre-existing injuries (ankle, back, knees, etc.) that might be aggravated by the activities?*

If Yes, please specify:
Do you have any allergies?*

If Yes, please specify:
Do you carry an Epi-Pen, inhaler, or similar device? If yes, please bring these medications with you. Your medication will be kept secure and readily accessible. If yes and you do not have it available, you are participating in the Activities at your own risk.*
If yes, I authorize Crossnore Staff to administer my medication, if necessary.
Do you have any other ability or health needs we should be aware of today?*

If Yes, please specify:
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
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*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information
Do you have any pre-existing injuries (ankle, back, knees, etc.) that might be aggravated by the activities?*

If Yes, please specify:
Do you have any allergies?*

If Yes, please specify:
Do you carry an Epi-Pen, inhaler, or similar device? If yes, please bring these medications with you. Your medication will be kept secure and readily accessible. If yes and you do not have it available, you are participating in the Activities at your own risk.*
If yes, I authorize Crossnore Staff to administer my medication, if necessary.
Do you have any other ability or health needs we should be aware of today?*

If Yes, please specify:
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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