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Outdoor Programs Waiver 


In the event medical clearance must be obtained prior to participation in this Program, the participant agrees to consult with their medical provider and obtain written permission from him or her prior to starting the Program.


EMERGENCY TREATMENT: In the event I, and/or my child, experience a medical emergency I authorize the Town of Waterville Valley (“Waterville Valley”), including but not limited to, its Recreation Department to provide emergency medical care, including if determined necessary, transport to a medical facility. In the event of any injury or illness, Waterville Valley will attempt to contact the person(s) identified as "Emergency Contact" prior to transport but I understand and agree if the emergency contact is unreachable Waterville Valley is authorized to act as medically necessary if emergent treatment is required. I agree to pay all costs associated with said treatment, including transportation to a medical facility.

ASSUMPTION OF RISK and RELESE AND WAIVER OF LIABILITY AND INDEMNIFICATION 

I understand and agree that each participant is responsible for their own safety and I understand the nature and risk associated with participation in the Program listed above, which may be challenging and may include significant risk of injury including in rare cases, death. In consideration for being allowed to use the Waterville Valley facilities and participate in its programming I, the undersigned, agree to assume the risk for my, and/or my child’s participation and on behalf of myself, my heirs and assigns waive and release any and all claims of damage I ever had, or may have as a result of my participation against the Town of Waterville Valley, its officers, directors, employees, volunteers and successors and assigns, for any and all kinds of injury, including but not limited to personal and/or property damage or injury suffered by my child, or myself, while participating in the activity.

By my signature below I further agree to the fullest extent permitted by law to indemnify and hold harmless Waterville Valley, officers, directors, employees, volunteers and successors and assigns (“indemnified parties”) from all claims, costs, losses and damages arising out of third-party claims provided that any such claim, cost, loss or damage to the extent such claim is caused by any negligent or intentional act or omission of me or my child/ward.  

April 30, 2024

PHOTO RELEASE

I understand that from time to time, Waterville Valley or others contracted for promotional purposes may take photographs of participants in its Programs. By registering myself or my child/ward in a Waterville Valley Program, I agree that any photograph taken of myself or my child, may be used for the purpose of publicity or promotion of the Town of Waterville Valley Recreation programs without further notice or compensation to me or my heirs or assigns. If I wish that my, or my child/ward’s photo not be taken or used, I will submit a written request to be excluded to the Recreation Director prior to participation in the Program 



First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Allergies/Limitations

Please list participant's Allergies/Limitations
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Allergies/Limitations

Please list participant's Allergies/Limitations
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Allergies/Limitations

Please list participant's Allergies/Limitations
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Allergies/Limitations

Please list participant's Allergies/Limitations
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Allergies/Limitations

Please list participant's Allergies/Limitations
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Allergies/Limitations

Please list participant's Allergies/Limitations
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Allergies/Limitations

Please list participant's Allergies/Limitations
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Allergies/Limitations

Please list participant's Allergies/Limitations
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Allergies/Limitations

Please list participant's Allergies/Limitations
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Allergies/Limitations

Please list participant's Allergies/Limitations
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:*
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*

Emergency Contact's Relation to Participant
Emergency Contact #2

First Name

Last Name

Emergency contact's phone number

Emergency contact's relation to participant
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 Allergies/Limitations

Please list participant's Allergies/Limitations
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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