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Ropes Course Waiver

ACKNOWLEDGEMENT OF RISK AND RELEASE OF LIABILITY

Cross Bar X Youth Ranch Ropes Course Activities

Acknowledgement & Assumption of Risks

I recognize that there are significant risks inherent to participating in rock climbing, bouldering, and rappelling or traveling to sites where such activities are conducted (collectively, the “Ropes Course Program”), including but not limited to the risk of bodily injury, illness, death, damage or loss to person or property which may result from surface and subsurface hazards; severe weather; collisions with or impacts from other participants or natural or manmade objects; equipment failure; falls from heights; physically demanding tasks; traffic hazards; the potential of participants to act in a negligent or unpredictable manner that may contribute to injury to that participant or to others, such as failing to maintain control over equipment or tools or not acting within the participant’s abilities; and other hazards.. I understand that persons with certain medical conditions should not participate in the Ropes Course Program without the advice of a physician.

I acknowledge that a complete listing of risks is not possible, and that risks may exist that cannot be anticipated. I understand that supervision by Cross Bar X Youth Ranch and its owners, officers, directors, volunteers, agents, employees, counselors, and guides (collectively, “Cross Bar X”) may not be provided at all times.

I also acknowledge that Cross Bar X uses its best judgment in determining how to react to circumstances present in the Ropes Course Program, including physical hazards and a participant’s abilities, but may misjudge such circumstances.

Also, I acknowledge that equipment used in the Ropes Course Program may break, fail, or malfunction, despite reasonable maintenance and use. Some of the equipment used in these activities may inflict injuries even when used as intended.

I understand that participation in the Ropes Course Program is not required. Knowing these risks, I authorize participation by myself and my child in the Ropes Course Program, and assume responsibility for myself and my child for any and all bodily injury, illness, death, damage to or loss of personal property, and all expenses thereof, which may occur as a result of participation in such activities.

Release, Waiver of Liability, and Indemnification

PLEASE READ CAREFULLY BEFORE SIGNING. THIS DOCUMENT INCLUDES A RELEASE OF LIABILITY AND

WAIVER OF CERTAIN LEGAL RIGHTS.

In consideration of the right to participant in this activity, I release and agree not to sue Cross Bar X for any and all claims, actions, demands, damages, causes of action or suits of any kind or nature whatsoever (“Claims”) which may be asserted by or on behalf of myself or my child as a result of bodily injury, illness, death, damage or loss to person or property which may result from participation in the Ropes Course Program, whether or not caused by the negligence of Cross Bar X. In addition, I agree to indemnify, defend, and hold Cross Bar X harmless from and against any and all liability, loss or damage Cross Bar X may suffer as a result of Claims which may be asserted against Cross Bar X arising out of the activities carried out at Cross Bar X Youth Ranch or by Cross Bar X.

I have had a chance to ask questions and seek advice before signing this document

First Participant's Name
First Name*
Middle Name
Last Name*
Phone*
First Participant's Date of Birth*
Date of Birth
First Participant's Signature*
Second Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Third Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Fourth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Fifth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Sixth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Seventh Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Eighth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Ninth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Tenth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Parent or Guardian's Email Address
Email*
Confirm Email*
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Is the participant in good health and able to fully participate in a program that involves climbing, traversing, swinging, decending, and other strenuous high ropes adventure course activities?
Click to customize question*
No
Yes
If no, please explain.
Does the participant have any pre existing or current injuries that might impare or be aggravated as a result of climbing, decending, traversing, or falling on an high ropes adventure course?
Click to customize question*
No
Yes
If no, please explain.
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*
Middle Name
Last Name*
Phone*
Parent or Guardian's Date of Birth*
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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