Loading...

Individual Participant Waiver and Release Agreement, Challenge Course

The undersigned in consideration for the right to participate in an Outdoor Program (OP) Challenge Course, hereby agrees to this waiver and release.

I recognize that the Activity may have a risk of personal injury and/or damage to my property. I hereby freely assume all risks which may be associated with or result from participating in the Activity including, but not limited to:

1. A ropes or challenge course is a series of tasks, obstacles or challenges that the participants will travel through, on or around during the course. Most obstacles involving physical activity such as crawling, walking, climbing or movement using all or part of your body. Some of the obstacles will be off the ground, some quite high. Participants may experience exhaustion or tiredness from the course. A large amount of physical exertion will be required.

2. Participants may experience rope burns from the ropes or cables traveling through their hands. Participants can fall against the rope or other objects while on the course. Participants may fall to the ground from heights of varying distances.

3. Participants will often experience and confront several types of fear or trauma.

4. You need to understand that your involvement and participation in this activity is voluntary. You have the right and you must notify us if you do not want to participate in any or all of the activities. Do not allow your friends or other participants to influence your decision to participate or not participate. If at any time you are unsure, frightened, or unable to proceed please notify us at once and we will assist you in coming off the course.

5. The list of possible accidents stated above may inflict bodily injury, disease, strains, fractures, partial and/or total paralysis, death or other ailments that could cause serious disability. It is also possible that some participants would suffer mental anguish or trauma from the experience or their injuries.

6. This list is not an exclusive or exhaustive list of possible injuries, trauma or accidents that may occur while participating at our ropes challenge course. Most of these injuries are rare and you are not likely to encounter them, however they have occurred and you need to know about them and other possible injuries not mentioned above. These injuries occur more often when the participants are using drugs or alcohol or not physically able to undertake the activity.

7. Because certain activities are contraindicated with certain medical conditions, I affirm that if I have any mental or physical conditions or limitations that might compromise or affect my ability to participate in OP activities, I have discussed them with a licensed physician. Furthermore, if my physician or I feel it is important to share this medical condition with the OP and/or its staff, I will do so.

8. I agree that the OP has no responsibility for medical care provided to me, and I agree to pay all costs associated with such care.

9. I authorize and release to the OP the use of my image in any photograph, audio recording, or video recording for any purpose of the OP with no compensation of any kind afforded to me.

I further agree to release the State of Utah, Weber State University (WSU), their officers, employees, agents, contractors and volunteers (“Releasees”) from any and all liability, claims, demands, actions, loss, claim, damage, injury, illness, or harm (“Claims”) to me of any kind or nature arising out of participation in the Activity including where Claims occur due to the negligence of Releasees.

CONSENT

Consent is expressively given, in the event of injury, for any emergency aid, anesthesia, and/or operation, if in the opinion of the attending physician, such treatment is necessary.

I AM 18 YEARS OF AGE OR OLDER, HAVE CAREFULLY READ AND UNDERSTAND THE CONTENTS OF THE FOREGOING WAIVER AND RELEASE, AND I SPECIFICALLY INTEND IT TO COVER MY PARTICIPATION OR COMPETITION IN THE ABOVE DESCRIBED EVENT. 

*If participant is under 18 do not sign above, please use the informed consent below which must also be signed by a parent or legal guardian.

 

Today's Date: April 18, 2024


First Participant's Name

First Name*

Last Name*

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

W#
Select Applicable:
First Participant's Signature*
Second Participant's Name

First Name*

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

W#
Select Applicable:
Second Participant's Signature*
Third Participant's Name

First Name*

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

W#
Select Applicable:
Third Participant's Signature*
Fourth Participant's Name

First Name*

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

W#
Select Applicable:
Fourth Participant's Signature*
Fifth Participant's Name

First Name*

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

W#
Select Applicable:
Fifth Participant's Signature*
Sixth Participant's Name

First Name*

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

W#
Select Applicable:
Sixth Participant's Signature*
Seventh Participant's Name

First Name*

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

W#
Select Applicable:
Seventh Participant's Signature*
Eighth Participant's Name

First Name*

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

W#
Select Applicable:
Eighth Participant's Signature*
Ninth Participant's Name

First Name*

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

W#
Select Applicable:
Ninth Participant's Signature*
Tenth Participant's Name

First Name*

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

W#
Select Applicable:
Tenth Participant's Signature*
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*

Informed Consent for Minors and their Parent  

This is an informed consent form for minors, which identifies risks of participating in a Weber State University (“WSU”) activity or program, and a consent form for parents/guardians.

Parent or Guardian will read and sign this section: I have been informed of the nature of the Activity, listed in this document (see bullet points 1-9), which my minor child wishes to participate in. I recognize that the Activity may involve moderate to strenuous physical activity and may cause physical and or emotional distress to participants. I state that my minor child is free from any known heart, respiratory or other health problems that could prevent her or him from safely participating in the Activity. I consent to the participation of my minor child in the Activity. CONSENT Consent is expressively given, in the event of injury, for any emergency aid, anesthesia, and/or operation, if in the opinion of the attending physician, such treatment is necessary. 

CONSENT

Consent is expressively given, in the event of injury, for any emergency aid, anesthesia, and/or operation, if in the opinion of the attending physician, such treatment is necessary. 

Participating minor child will read and sign this section: I desire to participate in the Activity described above. I agree to familiarize myself with the Activity and what is required, rules of conduct and safety equipment. I agree to follow proper operating procedures including safety procedures as outlined by the Activity leader, plus any directions given by WSU personnel. I agree to follow the rules of conduct and use the provided safety equipment. 




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

W#
Select Applicable:
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! and  Rock Gym Pro