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PARTICIPATION AGREEMENT, RELEASE, AND ACKNOWLEDGMENT OF RISKS

In consideration of the services of Crux Wilderness Therapy (hereafter collectively referred to as CWT), their agents, officers, directors, employees, representatives, volunteers, and all other persons or entities acting in capacity on their behalf (the “Released Parties”), I hereby agree to release, indemnify, and discharge CWT, through this Participation Agreement, Release, and Acknowledgment of Risks (the “Agreement”) on behalf of myself, my children, my parents, my heirs, assigns, personal representatives, and estate as follows;

I acknowledge that my participation in CWT activities entails known and unanticipated risks that could result in physical or emotional injury, paralysis, death, or damage to myself, to property, or to third parties. Risks involved are included in the following and are not limited to: General Risks, such as equipment failure or malfunction, slips or falls onto rocks or rock surfaces, falling rocks, avalanches, animal, snake, or poisonous insect encounters, contact with poisonous or prickly plants, inaccessibility of medical care in the event of illness of accident. Weather Related Risks, exposure to cold, sun, and extreme temperatures, sudden weather changes, lightning, heavy precipitation, high winds. Participant Related Risks, failure to follow instructions, failure to properly use the equipment, negligent or careless actions, poor balance, physical coordination, or strength; careless, or negligent actions by co-participants. Guide Related Risks, judgement error as to estimating participant readiness or ability, the adequacy of instructions or warnings, in anticipating weather conditions, in selection of route or challenge, in evaluating equipment.

I do hereby affirm and acknowledge that I have been fully informed of the inherent hazards and risks associated with CWT activities. I further acknowledge and understand that these inherent hazards and risks cannot be entirely eliminated. I fully understand and agree that CWT has not tried to contradict or minimize your understanding of these risks. I understand that injuries and damages can occur by natural causes or activities of other persons, environmental circumstances, staff of CWT or other third parties, either as a result of negligence or because of other reasons. I understand the description of these risks is not complete and that unknown or unanticipated risks may result in injury, illness, or death.

Release of Liability, Waiver of Claims and Indemnity Agreement

In consideration for being permitted to participate in CWT activities, I release and acknowledge that:

  • To the fullest extent allowable by law, I do hereby WAIVE AND DISCHARGE CLAIMS AGAINST, RELEASE FROM LIABILITY, INDEMNIFY, AND HOLD HARMLESS THE RELEASED PARTIES 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 CWT activities whether caused by activity or passive NEGLIGENCE of the releases or otherwise.
  • I have read Section 1542 of the California Civil Code, which provides as follows: “A general release does not extend to claims which the creditor does not know or suspect to exist in his or her favor at the time of executing the release, which if known by him or her must have materially affected his or her settlement with the debtor.” I understand that Section 1542 allows a person not to release existing claims of which the person is presently unaware, unless the person voluntarily chooses to waive this right. Having been so apprised, I nevertheless hereby voluntarily elect to, and do, waive the rights described in Section 1542, and elect to assume all rights for claims that now exist in my favor, known or unknown, for the subject of this Agreement.
  • By entering into this Agreement, I am not relying on any oral or written representation or statement made by the releases, other than what is set forth in this Agreement.
  • I expressly agree to accept and assume all the risks existing in CWT activities. My participation in these activities are voluntary and I elect to participate in spite of the risks. page1image1662096 page1image1624864
  • Should CWT or anyone acting on their behalf be required to incur attorney’s fees and costs to enforce this agreement. I agree to indemnify them and hold them harmless for all such fees and costs.
  • All participants in the activities are strongly encouraged to purchase and maintain insurance during the entire length of the activities (including through their return date if they will be traveling). Participants that choose to purchase coverage are individually responsible for paying for insurance and ensuring adequate coverage. Coverage should ideally include, but not be limited to: illness, injury, property damage, loss of personal items, death, cancellation and any other potential losses, damages, expenses, and/or liabilities. CWT is not responsible or liable for any loss, damage, expense, cost, or any other travel-related issues. As such, I certify that I have adequate insurance to cover any injury or damage I may cause or suffer while participating in CWT activities, or else I agree to bear the costs of such injury or damage myself. I further certify that I am willing to assume the risks of any medical or physical condition I may have.
  • In the event that I file a lawsuit against CWT, I agree to do so solely in the state of California, and I further agree that the substantive law of the state shall apply in the action without regard to the conflict of law rules of the state.

Rules and Actions

  • I agree to obey all safety rules and instructions of the guide.
  • I agree to stay in areas designated and not enter areas that will place me in undue danger.
  • I agree to attempt only activities that I feel I am capable of performing safely.
  • I agree to not use racial or discriminatory language of any kind and if heard doing so one will be asked to leave the CWT clinic and not return to future clinics.
  • I understand that I am responsible for my own travel costs to and from the CWT activities.
  • I agree that, should I take part in any activities where food or beverages are provided and I have any dietary restrictions that need accommodation, I will share said dietary restrictions with the CWT as soon as possible. I understand that, should I delay in sharing any dietary restrictions with CWT, CWT cannot guarantee that my dietary restrictions will be accommodated. CWT and any chefs or caterers participating in the activities shall not be held liable for any illness or allergic reaction to any food items provided during the activities.
  • I understand that alcohol will not be provided by CWT during the activities. I agree to neither consume alcohol nor provide alcohol to others during the activities. Additionally, I agree to neither consume cannabis/marijuana nor provide cannabis/marijuana to others, whether medical or otherwise. I understand that CWT reserves the right to excuse me from the activities if CWT is made aware that I have violated this provision. If I am excused from the activities pursuant to this section, it shall be without any sort of refund or reimbursement by CWT.
  • I understand that I may not sell, assign, or transfer any of its rights or obligations hereunder, and any attempt to sell, assign, or transfer such rights or obligations without CWT’s prior written approval will be null and void. All terms and conditions in this Agreement will be binding upon and inure to the benefit of the parties hereto and their respective permitted transferees, successors, and assigns.

Health and Safety

  • I acknowledge, understand, and agree that any services provided by CWT are not part of a licensed therapy program.
  • I acknowledge CWT recommends getting medical clearance prior to participation in CWT activities.
  • I possess a sufficient level of skill and physical fitness for safe participation in CWT activities.
  • I have no health problems that would make participation in CWT activities unwise. I agree and verify that any and all of the information that I have given CWT and its representatives is accurate, up-to-date, and without the omission of any known medical issues.
  • I agree that if I experience any medical issues while taking part in CWT activities, I will contact my doctor immediately.
  • I understand and agree that it is my responsibility to let CWT know if I find myself in any pain or discomfort before, after, or during the activities.
  • I authorize CWT to administer emergency first aid and/ or CPR when deemed necessary by CWT.
  • I authorize CWT to secure emergency medical care, rescue, and transportation (e.g., EMS) when deemed necessary by CWT and I agree to assume all costs of emergency medical care, rescue, and transportation.
  • I acknowledge and agree that any consent given for emergency medical care does not impose a duty upon CWT to provide such assistance, transportation, or services. I agree that I alone am responsible for the payment of any medical costs and agrees to hold CWT blameless from any charges, fees, or costs that my health conditions may incur. I ACKNOWLEDGE THAT ANY INJURIES THAT I MAY SUSTAIN MAY BE COMPOUNDED BY NEGLIGENT FIRST AID OR EMERGENCY RESPONSE OF THE RELEASED PARTIES OR OTHER INDIVIDUALS OR MEDICAL OR EMERGENCY PERSONNEL.
  • I understand and agree that CWT shall attempt to reach the Emergency Contact listed below, should Participant require medical attention or treatment, but in the event CWT cannot reach that Emergency Contact and authorizes medical treatment in their discretion, in no way shall CWT be liable for any harm that may arise from the lack of contact or any medical treatment authorized without input from the Emergency Contact.
  • Both CWT and I specifically acknowledge and agree that these clauses are not intended to be a general release, which would be limited under some state and local laws.

Photo/Video Release

  • I understand and agree that CWT may collect, record, publish, post, transmit, and/or display my name, image and likeness and quotes, and testimonial (this includes name, biographical information, likeness, portrait, image, picture, voice, quotes, all or parts of interviews and information obtained from interviews) (collectively the “Media”) for any marketing or advertising purpose, including but not limited to for use on CWT’s website and social media channels.
  • I hereby voluntarily release and hold harmless the Released Parties from all manner of suits, actions, claims, demands, and liabilities which may arise from such Media participation. This release applies to any and all media known, and hereafter devised.
  • I understand that all media remains the property of CWT, and I waive all rights to original Media, copies of Media, royalties, entitlements, payments, or any other compensation or quid pro benefits which might arise from CWT’s acquisition, storage, display, publication, posting, or distribution of media as described herein.
  • I understand that this Agreement constitutes a full and complete waiver of all possible claims of any nature whatsoever, including claims of negligence, personal injury or property loss, or damage, arising out of said Media participation.
  • This release shall be binding to the fullest extent permitted by law. If any provisions of the release is found to be, in whole or in part, to be unenforceable for any reason,the remainder of that provision and of the entire Agreement will be severable and remain in effect..

I HAVE HAD SUFFICIENT OPPORTUNITY TO READ THIS AGREEMENT, AND I FULLY UNDERSTAND ITS TERMS, AND UNDERSTAND THAT I HAVE GIVEN UP LEGAL RIGHTS BY SIGNING IT, AND I SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.


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First Participant's Name

First Name*

Last Name*

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

Email*

Confirm Email*
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*

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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