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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 ​Beanstalk Forest​ 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;

2) 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;

3) 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

4) 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

The Participant and his/her parent(s)/legal guardian(s) certify that Participant has no physical or mental condition that precludes him/her from participating in the Activities and that he/she is not participating against medical advice.

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 senseand 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.

I HAVE READ AND UNDERSTAND THIS AGREEMENT AND I AM AWARE THAT BY SIGNING THIS AGREEMENT I MAY BE WAIVING CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE. 

Date: March 29, 2024

This authorization is good for a period of 1 year from the date signed above unless otherwise noted.

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information

Weight (Maximum Weight of 300 lbs.): *

Any pertinent medical information guiding staff should be aware of, including limitations or medications (e.g. allergies, prior broken bones, current physical concerns):
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information

Weight (Maximum Weight of 300 lbs.): *

Any pertinent medical information guiding staff should be aware of, including limitations or medications (e.g. allergies, prior broken bones, current physical concerns):
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information

Weight (Maximum Weight of 300 lbs.): *

Any pertinent medical information guiding staff should be aware of, including limitations or medications (e.g. allergies, prior broken bones, current physical concerns):
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information

Weight (Maximum Weight of 300 lbs.): *

Any pertinent medical information guiding staff should be aware of, including limitations or medications (e.g. allergies, prior broken bones, current physical concerns):
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information

Weight (Maximum Weight of 300 lbs.): *

Any pertinent medical information guiding staff should be aware of, including limitations or medications (e.g. allergies, prior broken bones, current physical concerns):
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information

Weight (Maximum Weight of 300 lbs.): *

Any pertinent medical information guiding staff should be aware of, including limitations or medications (e.g. allergies, prior broken bones, current physical concerns):
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information

Weight (Maximum Weight of 300 lbs.): *

Any pertinent medical information guiding staff should be aware of, including limitations or medications (e.g. allergies, prior broken bones, current physical concerns):
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information

Weight (Maximum Weight of 300 lbs.): *

Any pertinent medical information guiding staff should be aware of, including limitations or medications (e.g. allergies, prior broken bones, current physical concerns):
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information

Weight (Maximum Weight of 300 lbs.): *

Any pertinent medical information guiding staff should be aware of, including limitations or medications (e.g. allergies, prior broken bones, current physical concerns):
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information

Weight (Maximum Weight of 300 lbs.): *

Any pertinent medical information guiding staff should be aware of, including limitations or medications (e.g. allergies, prior broken bones, current physical concerns):
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

Weight (Maximum Weight of 300 lbs.): *

Any pertinent medical information guiding staff should be aware of, including limitations or medications (e.g. allergies, prior broken bones, current physical concerns):
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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