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Express Assumption of Risk Associated with Mountaineering, Climbing, and Related Activities

I do hereby affirm and acknowledge that I have been fully informed of the inherent hazards and risks associated with Mountaineering, Rock/Ice Climbing, Hiking, Via Ferrata, Backcountry Skiing, transportation of equipment related to the activities, and travel to and from activity sites of which I am about to engage in.

Inherent hazards and risks include but are not limited to:

1. Risk of injury from the activity and equipment utilized in Mountaineering, Rock/Ice Climbing, Hiking, Via Ferrata, and Backcountry Skiing is significant including the potential for permanent disability and death.

2. Possible equipment failure and/or malfunction of my own or others’ equipment.

3. My own negligence and/or the negligence of others, including employees, agents, independent contractors or representatives of Splitter Alpine Adventures, LLC, including but not limited to operator error.

4. Injury to hands, fingers, feet, and toes, including but not limited to inflammation and/or strain of muscles ligaments and/or tendons, nerve damage or compression, and broken bones.

5. Injury from falling may occur from exposure to high altitude, which may affect judgment and coordination, or from not paying close attention to your climbing or others climbing with or near you.

6. Broken bones, severe injuries to the head, neck, and back which may result in severe physical impairment or even death.

7. Discharge of weapons in or near the area of activity.

8. Cold weather and heat related injuries and illness including but not limited to frostnip, frostbite, heat exhaustion, heat stroke, sunburn, hypothermia, and dehydration.

9. Exposure to outdoor elements, including but not limited to avalanche, rock fall, inclement weather, thunder and lightning, severe and or varied wind, temperature or weather conditions.

10. Attack by or encounter with insects, reptiles, and/or animals.

11. Exposure to airborne or waterborne viruses, bacteria, pathogens, or infectious disease.

12. Accidents or illness occurring in remote places where there are no available medical facilities, and where evacuation may be untimely or impossible.

13. Fatigue, chill, and/or dizziness, which may diminish my/our reaction time and increase the risk of accident.

14. My sense of balance, physical coordination, and ability to follow instructions.

*I understand the description of these risks is not complete and that unknown or unanticipated risks may result in physical or psychological injury, illness, economical or emotional loss, or death.

Release of Liability, Waiver of Claims and Indemnity Agreement

In consideration for being permitted to participate in any way in Mountaineering, Rock/Ice Climbing, Skiing and related activities, I hereby agree, acknowledge and appreciate that:

1. I HEREBY RELEASE AND HOLD HARMLESS WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, OR LOSS OR DAMAGE TO PERSON OR PROPERTY, WHETHER CAUSED BY NEGLIGENCE OR OTHERWISE, the following named persons or entities, herein referred to as “releasees”: Splitter Alpine Adventures, LLC.

2. To release the releasees, their agents, owners, officers, employees, contractors, volunteers, participants, employees, and all other persons or entities acting in any capacity on their behalf from any and all liability and responsibility whatsoever and for any claims or causes of action that I, my estate, heirs, survivors, executors, or assigns may have for personal injury, property damage, or wrongful death arising from the above activities whether caused by activity or passive negligence of the releasees or otherwise. By executing the document, I agree to hold the releasees harmless and indemnify them in conjunction with any injury, disability, death, or loss or damage to person or property and lawsuit that may occur as a result of engaging in the above activities.

3. By entering into this Agreement, I am not relying on any oral or written representation or statement made by the releasees, other than what is set forth in this Agreement.

This release shall be binding to the fullest extent permitted by law. If any provisions of the release is found to be unenforceable, the remaining terms shall be enforced.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, AND I FULLY UNDERSTAND ITS TERM, AND UNDERSTAND THAT I HAVE GIVEN UP LEGAL RIGHTS BY SIGNING IT, AND I SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*

Phone*
Second Participant's Date of Birth*
Second Participant's Signature*
Third Participant's Name

First Name*

Last Name*

Phone*
Third Participant's Date of Birth*
Third Participant's Signature*
Fourth Participant's Name

First Name*

Last Name*

Phone*
Fourth Participant's Date of Birth*
Fourth Participant's Signature*
Fifth Participant's Name

First Name*

Last Name*

Phone*
Fifth Participant's Date of Birth*
Fifth Participant's Signature*
Sixth Participant's Name

First Name*

Last Name*

Phone*
Sixth Participant's Date of Birth*
Sixth Participant's Signature*
Seventh Participant's Name

First Name*

Last Name*

Phone*
Seventh Participant's Date of Birth*
Seventh Participant's Signature*
Eighth Participant's Name

First Name*

Last Name*

Phone*
Eighth Participant's Date of Birth*
Eighth Participant's Signature*
Ninth Participant's Name

First Name*

Last Name*

Phone*
Ninth Participant's Date of Birth*
Ninth Participant's Signature*
Tenth Participant's Name

First Name*

Last Name*

Phone*
Tenth Participant's Date of Birth*
Tenth Participant's Signature*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive email updates and information from Splitter Alpine Adventures. No spam, I promise!
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*

Emergency Contact's Relation to Participant
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:*
Medical Info

What is your current general level of health? *

Have you been ill or hospitalized in the past 2 years? If yes, please describe. *
Do you currently or have you ever had any of the following? *
Musculoskeletal injury
Circulation problems
Head injury
Spinal injury
Migraines
Diabetes
Asthma
High or low blood pressure
Cardiovascular disease
Seizures
Hearing or visual impairements
Limb difference
Other
No, I do not have any of the listed medical conditions

Do you currently take any medication? Please list the medication and describe its purpose. *
Have you ever had frostbite or any other cold injury?*
No
Yes
Have you ever had any form of altitude illness?*
No
Yes

Do you have any allergies (food, medicine, environmental)? If yes, please describe. *

Are there any accommodations/assistance that you'd prefer to make your guided experience more enjoyable?
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*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
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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