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WAIVER AND RELEASE OF LIABILITY



      I hereby acknowledge and agree that in consideration of being permitted to participate in Frontier Camping   Society programs, races or activities organized, operated or sanctioned by Frontier Lodge, herein called “the Lodge”:  

1. I do hereby release, waive and discharge the Lodge, its members, officers, directors, independent contractors, employees, volunteers and agents, all recourse, proceedings, claims and causes of action of any kind whatsoever, in respect of all personal injuries or property losses which I may suffer arising out of or connected with, my preparation for, or participation in, the aforesaid programs, races or activities EXCEPT where and to the extent such personal injuries or property losses arise out of the negligent acts or omissions of the Lodge, its members, officers, directors, independent contractors, employees, volunteers or agents. This Waiver and   Release extends to all claims of every nature or kind whatsoever, foreseen or unforeseen, known or unknown.  

2. And, I hereby acknowledge and agree:  

a) that wilderness activities and programs are very dangerous, exposing participants to many risks and hazards;  

b) that, as a result of the aforesaid risks and hazards, I, as a participant, may suffer serious personal injury, even death, as well as property loss;  

c) that some of the aforesaid risks and hazards are foreseeable, but others are not;  

d) that I nevertheless freely and voluntarily assume all the aforesaid risks and hazards, and that, accordingly, my preparation for, and participation in the aforesaid programs, races and activities shall be entirely at my own risk;  

e) that the Lodge may use photographs or videos that I appear in for promotional purposes; 

f) that the Lodge may keep my information on file for a minimum of three years and that my information will be kept confidential and not sold or given to any other organization;  

g) that I carefully read the WAIVER AND RELEASE agreement, that I fully understand and accept its terms, and that I am freely and voluntarily executing the same;  

h) that this WAIVER AND RELEASE agreement is binding on myself, my heirs, my executors, administrators, personal representatives and assigns.  

3. In the event of any injury or illness, I authorize the Lodge staff or their designate to seek and obtain such emergency or medical services as may be deemed necessary at the time. 


Parent/Guardian Authorization (if participant is under 18)

I, the parent or guardian of the below-named minor(s), acknowledge that I carefully read this WAIVER AND RELEASE agreement, that I fully understand and accept its terms, that, on the behalf of my child, I am freely and voluntarily executing the same, and that I give full permission for the below-named minor(s) to participate in all Frontier Lodge program activities and any transportation to and from those activities. I acknowledge and give consent and permission for Frontier Lodge Staff to administer acetaminophen   (Tylenol), ibuprofen (Advil), antihistamine (Benadryl), and/or antibiotic ointment (Polysporin) to the below-named minor(s) if indicated. 

First Participant's Name

First Name*

Last Name*

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

FOOD ALLERGIES

COMMON DIETS

  • Gluten Free
  • Peanuts
  • Vegetarian
  • Dairy Free
  • Egg Free

Be as descriptive as possible regarding diets to help us serve you better.

1. Food Allergy

Rate the severity of your food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Food Allergy. Leave empty if not applicable.

2. Food Allergy

Rate the severity of your food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Food Allergy and required treatment practices if triggered. Leave empty if not applicable.

3. Food Allergy

Rate the severity of your food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Food Allergy and required treatment practices if triggered. Leave empty if not applicable.

NON-FOOD ALLERGIES (i.e. Medications, Animals/Insects, Seasonal Allergies, etc.)


1. Non-Food Allergy

Rate the severity of your non-food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Non-Food Allergy. Leave empty if not applicable.

2. Non-Food Allergy

Rate the severity of your non-food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Non-Food Allergy. Leave empty if not applicable.

3. Non-Food Allergy

Rate the severity of the Non-Food Allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Non-Food Allergy and required treatment practices if triggered. Leave empty if not applicable.

MEDICAL CONDITIONS

Do you have any medical conditions?*
No
Yes

Clearly describe any medical conditions and any related concerns about your adventure experience. Leave empty if unapplicable.

MEDICAL HISTORY

Do you have any relevant past medical history such as injuries or surgeries?*
No
Yes

Clearly describe the past medical history including when it happened. Leave empty if unapplicable.

MEDICATIONS

Are you currently taking medications? (i.e Epipen, seasonal allergy meds, other)*
No
Yes

Clearly list the medications name, purpose and how often you take it. Leave empty if unapplicable.

SWIMMING ABILITY

Rate Your Swimming Ability*
Beginner - Assistance Required
Beginner - No Assistance Required
Intermediate
Advanced or Higher
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*

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

FOOD ALLERGIES

COMMON DIETS

  • Gluten Free
  • Peanuts
  • Vegetarian
  • Dairy Free
  • Egg Free

Be as descriptive as possible regarding diets to help us serve you better.

1. Food Allergy

Rate the severity of your food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Food Allergy. Leave empty if not applicable.

2. Food Allergy

Rate the severity of your food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Food Allergy and required treatment practices if triggered. Leave empty if not applicable.

3. Food Allergy

Rate the severity of your food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Food Allergy and required treatment practices if triggered. Leave empty if not applicable.

NON-FOOD ALLERGIES (i.e. Medications, Animals/Insects, Seasonal Allergies, etc.)


1. Non-Food Allergy

Rate the severity of your non-food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Non-Food Allergy. Leave empty if not applicable.

2. Non-Food Allergy

Rate the severity of your non-food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Non-Food Allergy. Leave empty if not applicable.

3. Non-Food Allergy

Rate the severity of the Non-Food Allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Non-Food Allergy and required treatment practices if triggered. Leave empty if not applicable.

MEDICAL CONDITIONS

Do you have any medical conditions?*
No
Yes

Clearly describe any medical conditions and any related concerns about your adventure experience. Leave empty if unapplicable.

MEDICAL HISTORY

Do you have any relevant past medical history such as injuries or surgeries?*
No
Yes

Clearly describe the past medical history including when it happened. Leave empty if unapplicable.

MEDICATIONS

Are you currently taking medications? (i.e Epipen, seasonal allergy meds, other)*
No
Yes

Clearly list the medications name, purpose and how often you take it. Leave empty if unapplicable.

SWIMMING ABILITY

Rate Your Swimming Ability*
Beginner - Assistance Required
Beginner - No Assistance Required
Intermediate
Advanced or Higher
Third Participant's Name

First Name*

Last Name*

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

FOOD ALLERGIES

COMMON DIETS

  • Gluten Free
  • Peanuts
  • Vegetarian
  • Dairy Free
  • Egg Free

Be as descriptive as possible regarding diets to help us serve you better.

1. Food Allergy

Rate the severity of your food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Food Allergy. Leave empty if not applicable.

2. Food Allergy

Rate the severity of your food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Food Allergy and required treatment practices if triggered. Leave empty if not applicable.

3. Food Allergy

Rate the severity of your food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Food Allergy and required treatment practices if triggered. Leave empty if not applicable.

NON-FOOD ALLERGIES (i.e. Medications, Animals/Insects, Seasonal Allergies, etc.)


1. Non-Food Allergy

Rate the severity of your non-food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Non-Food Allergy. Leave empty if not applicable.

2. Non-Food Allergy

Rate the severity of your non-food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Non-Food Allergy. Leave empty if not applicable.

3. Non-Food Allergy

Rate the severity of the Non-Food Allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Non-Food Allergy and required treatment practices if triggered. Leave empty if not applicable.

MEDICAL CONDITIONS

Do you have any medical conditions?*
No
Yes

Clearly describe any medical conditions and any related concerns about your adventure experience. Leave empty if unapplicable.

MEDICAL HISTORY

Do you have any relevant past medical history such as injuries or surgeries?*
No
Yes

Clearly describe the past medical history including when it happened. Leave empty if unapplicable.

MEDICATIONS

Are you currently taking medications? (i.e Epipen, seasonal allergy meds, other)*
No
Yes

Clearly list the medications name, purpose and how often you take it. Leave empty if unapplicable.

SWIMMING ABILITY

Rate Your Swimming Ability*
Beginner - Assistance Required
Beginner - No Assistance Required
Intermediate
Advanced or Higher
Fourth Participant's Name

First Name*

Last Name*

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

FOOD ALLERGIES

COMMON DIETS

  • Gluten Free
  • Peanuts
  • Vegetarian
  • Dairy Free
  • Egg Free

Be as descriptive as possible regarding diets to help us serve you better.

1. Food Allergy

Rate the severity of your food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Food Allergy. Leave empty if not applicable.

2. Food Allergy

Rate the severity of your food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Food Allergy and required treatment practices if triggered. Leave empty if not applicable.

3. Food Allergy

Rate the severity of your food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Food Allergy and required treatment practices if triggered. Leave empty if not applicable.

NON-FOOD ALLERGIES (i.e. Medications, Animals/Insects, Seasonal Allergies, etc.)


1. Non-Food Allergy

Rate the severity of your non-food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Non-Food Allergy. Leave empty if not applicable.

2. Non-Food Allergy

Rate the severity of your non-food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Non-Food Allergy. Leave empty if not applicable.

3. Non-Food Allergy

Rate the severity of the Non-Food Allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Non-Food Allergy and required treatment practices if triggered. Leave empty if not applicable.

MEDICAL CONDITIONS

Do you have any medical conditions?*
No
Yes

Clearly describe any medical conditions and any related concerns about your adventure experience. Leave empty if unapplicable.

MEDICAL HISTORY

Do you have any relevant past medical history such as injuries or surgeries?*
No
Yes

Clearly describe the past medical history including when it happened. Leave empty if unapplicable.

MEDICATIONS

Are you currently taking medications? (i.e Epipen, seasonal allergy meds, other)*
No
Yes

Clearly list the medications name, purpose and how often you take it. Leave empty if unapplicable.

SWIMMING ABILITY

Rate Your Swimming Ability*
Beginner - Assistance Required
Beginner - No Assistance Required
Intermediate
Advanced or Higher
Fifth Participant's Name

First Name*

Last Name*

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

FOOD ALLERGIES

COMMON DIETS

  • Gluten Free
  • Peanuts
  • Vegetarian
  • Dairy Free
  • Egg Free

Be as descriptive as possible regarding diets to help us serve you better.

1. Food Allergy

Rate the severity of your food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Food Allergy. Leave empty if not applicable.

2. Food Allergy

Rate the severity of your food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Food Allergy and required treatment practices if triggered. Leave empty if not applicable.

3. Food Allergy

Rate the severity of your food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Food Allergy and required treatment practices if triggered. Leave empty if not applicable.

NON-FOOD ALLERGIES (i.e. Medications, Animals/Insects, Seasonal Allergies, etc.)


1. Non-Food Allergy

Rate the severity of your non-food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Non-Food Allergy. Leave empty if not applicable.

2. Non-Food Allergy

Rate the severity of your non-food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Non-Food Allergy. Leave empty if not applicable.

3. Non-Food Allergy

Rate the severity of the Non-Food Allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Non-Food Allergy and required treatment practices if triggered. Leave empty if not applicable.

MEDICAL CONDITIONS

Do you have any medical conditions?*
No
Yes

Clearly describe any medical conditions and any related concerns about your adventure experience. Leave empty if unapplicable.

MEDICAL HISTORY

Do you have any relevant past medical history such as injuries or surgeries?*
No
Yes

Clearly describe the past medical history including when it happened. Leave empty if unapplicable.

MEDICATIONS

Are you currently taking medications? (i.e Epipen, seasonal allergy meds, other)*
No
Yes

Clearly list the medications name, purpose and how often you take it. Leave empty if unapplicable.

SWIMMING ABILITY

Rate Your Swimming Ability*
Beginner - Assistance Required
Beginner - No Assistance Required
Intermediate
Advanced or Higher
Sixth Participant's Name

First Name*

Last Name*

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

FOOD ALLERGIES

COMMON DIETS

  • Gluten Free
  • Peanuts
  • Vegetarian
  • Dairy Free
  • Egg Free

Be as descriptive as possible regarding diets to help us serve you better.

1. Food Allergy

Rate the severity of your food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Food Allergy. Leave empty if not applicable.

2. Food Allergy

Rate the severity of your food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Food Allergy and required treatment practices if triggered. Leave empty if not applicable.

3. Food Allergy

Rate the severity of your food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Food Allergy and required treatment practices if triggered. Leave empty if not applicable.

NON-FOOD ALLERGIES (i.e. Medications, Animals/Insects, Seasonal Allergies, etc.)


1. Non-Food Allergy

Rate the severity of your non-food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Non-Food Allergy. Leave empty if not applicable.

2. Non-Food Allergy

Rate the severity of your non-food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Non-Food Allergy. Leave empty if not applicable.

3. Non-Food Allergy

Rate the severity of the Non-Food Allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Non-Food Allergy and required treatment practices if triggered. Leave empty if not applicable.

MEDICAL CONDITIONS

Do you have any medical conditions?*
No
Yes

Clearly describe any medical conditions and any related concerns about your adventure experience. Leave empty if unapplicable.

MEDICAL HISTORY

Do you have any relevant past medical history such as injuries or surgeries?*
No
Yes

Clearly describe the past medical history including when it happened. Leave empty if unapplicable.

MEDICATIONS

Are you currently taking medications? (i.e Epipen, seasonal allergy meds, other)*
No
Yes

Clearly list the medications name, purpose and how often you take it. Leave empty if unapplicable.

SWIMMING ABILITY

Rate Your Swimming Ability*
Beginner - Assistance Required
Beginner - No Assistance Required
Intermediate
Advanced or Higher
Seventh Participant's Name

First Name*

Last Name*

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

FOOD ALLERGIES

COMMON DIETS

  • Gluten Free
  • Peanuts
  • Vegetarian
  • Dairy Free
  • Egg Free

Be as descriptive as possible regarding diets to help us serve you better.

1. Food Allergy

Rate the severity of your food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Food Allergy. Leave empty if not applicable.

2. Food Allergy

Rate the severity of your food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Food Allergy and required treatment practices if triggered. Leave empty if not applicable.

3. Food Allergy

Rate the severity of your food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Food Allergy and required treatment practices if triggered. Leave empty if not applicable.

NON-FOOD ALLERGIES (i.e. Medications, Animals/Insects, Seasonal Allergies, etc.)


1. Non-Food Allergy

Rate the severity of your non-food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Non-Food Allergy. Leave empty if not applicable.

2. Non-Food Allergy

Rate the severity of your non-food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Non-Food Allergy. Leave empty if not applicable.

3. Non-Food Allergy

Rate the severity of the Non-Food Allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Non-Food Allergy and required treatment practices if triggered. Leave empty if not applicable.

MEDICAL CONDITIONS

Do you have any medical conditions?*
No
Yes

Clearly describe any medical conditions and any related concerns about your adventure experience. Leave empty if unapplicable.

MEDICAL HISTORY

Do you have any relevant past medical history such as injuries or surgeries?*
No
Yes

Clearly describe the past medical history including when it happened. Leave empty if unapplicable.

MEDICATIONS

Are you currently taking medications? (i.e Epipen, seasonal allergy meds, other)*
No
Yes

Clearly list the medications name, purpose and how often you take it. Leave empty if unapplicable.

SWIMMING ABILITY

Rate Your Swimming Ability*
Beginner - Assistance Required
Beginner - No Assistance Required
Intermediate
Advanced or Higher
Eighth Participant's Name

First Name*

Last Name*

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

FOOD ALLERGIES

COMMON DIETS

  • Gluten Free
  • Peanuts
  • Vegetarian
  • Dairy Free
  • Egg Free

Be as descriptive as possible regarding diets to help us serve you better.

1. Food Allergy

Rate the severity of your food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Food Allergy. Leave empty if not applicable.

2. Food Allergy

Rate the severity of your food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Food Allergy and required treatment practices if triggered. Leave empty if not applicable.

3. Food Allergy

Rate the severity of your food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Food Allergy and required treatment practices if triggered. Leave empty if not applicable.

NON-FOOD ALLERGIES (i.e. Medications, Animals/Insects, Seasonal Allergies, etc.)


1. Non-Food Allergy

Rate the severity of your non-food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Non-Food Allergy. Leave empty if not applicable.

2. Non-Food Allergy

Rate the severity of your non-food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Non-Food Allergy. Leave empty if not applicable.

3. Non-Food Allergy

Rate the severity of the Non-Food Allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Non-Food Allergy and required treatment practices if triggered. Leave empty if not applicable.

MEDICAL CONDITIONS

Do you have any medical conditions?*
No
Yes

Clearly describe any medical conditions and any related concerns about your adventure experience. Leave empty if unapplicable.

MEDICAL HISTORY

Do you have any relevant past medical history such as injuries or surgeries?*
No
Yes

Clearly describe the past medical history including when it happened. Leave empty if unapplicable.

MEDICATIONS

Are you currently taking medications? (i.e Epipen, seasonal allergy meds, other)*
No
Yes

Clearly list the medications name, purpose and how often you take it. Leave empty if unapplicable.

SWIMMING ABILITY

Rate Your Swimming Ability*
Beginner - Assistance Required
Beginner - No Assistance Required
Intermediate
Advanced or Higher
Ninth Participant's Name

First Name*

Last Name*

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

FOOD ALLERGIES

COMMON DIETS

  • Gluten Free
  • Peanuts
  • Vegetarian
  • Dairy Free
  • Egg Free

Be as descriptive as possible regarding diets to help us serve you better.

1. Food Allergy

Rate the severity of your food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Food Allergy. Leave empty if not applicable.

2. Food Allergy

Rate the severity of your food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Food Allergy and required treatment practices if triggered. Leave empty if not applicable.

3. Food Allergy

Rate the severity of your food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Food Allergy and required treatment practices if triggered. Leave empty if not applicable.

NON-FOOD ALLERGIES (i.e. Medications, Animals/Insects, Seasonal Allergies, etc.)


1. Non-Food Allergy

Rate the severity of your non-food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Non-Food Allergy. Leave empty if not applicable.

2. Non-Food Allergy

Rate the severity of your non-food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Non-Food Allergy. Leave empty if not applicable.

3. Non-Food Allergy

Rate the severity of the Non-Food Allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Non-Food Allergy and required treatment practices if triggered. Leave empty if not applicable.

MEDICAL CONDITIONS

Do you have any medical conditions?*
No
Yes

Clearly describe any medical conditions and any related concerns about your adventure experience. Leave empty if unapplicable.

MEDICAL HISTORY

Do you have any relevant past medical history such as injuries or surgeries?*
No
Yes

Clearly describe the past medical history including when it happened. Leave empty if unapplicable.

MEDICATIONS

Are you currently taking medications? (i.e Epipen, seasonal allergy meds, other)*
No
Yes

Clearly list the medications name, purpose and how often you take it. Leave empty if unapplicable.

SWIMMING ABILITY

Rate Your Swimming Ability*
Beginner - Assistance Required
Beginner - No Assistance Required
Intermediate
Advanced or Higher
Tenth Participant's Name

First Name*

Last Name*

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

FOOD ALLERGIES

COMMON DIETS

  • Gluten Free
  • Peanuts
  • Vegetarian
  • Dairy Free
  • Egg Free

Be as descriptive as possible regarding diets to help us serve you better.

1. Food Allergy

Rate the severity of your food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Food Allergy. Leave empty if not applicable.

2. Food Allergy

Rate the severity of your food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Food Allergy and required treatment practices if triggered. Leave empty if not applicable.

3. Food Allergy

Rate the severity of your food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Food Allergy and required treatment practices if triggered. Leave empty if not applicable.

NON-FOOD ALLERGIES (i.e. Medications, Animals/Insects, Seasonal Allergies, etc.)


1. Non-Food Allergy

Rate the severity of your non-food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Non-Food Allergy. Leave empty if not applicable.

2. Non-Food Allergy

Rate the severity of your non-food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Non-Food Allergy. Leave empty if not applicable.

3. Non-Food Allergy

Rate the severity of the Non-Food Allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Non-Food Allergy and required treatment practices if triggered. Leave empty if not applicable.

MEDICAL CONDITIONS

Do you have any medical conditions?*
No
Yes

Clearly describe any medical conditions and any related concerns about your adventure experience. Leave empty if unapplicable.

MEDICAL HISTORY

Do you have any relevant past medical history such as injuries or surgeries?*
No
Yes

Clearly describe the past medical history including when it happened. Leave empty if unapplicable.

MEDICATIONS

Are you currently taking medications? (i.e Epipen, seasonal allergy meds, other)*
No
Yes

Clearly list the medications name, purpose and how often you take it. Leave empty if unapplicable.

SWIMMING ABILITY

Rate Your Swimming Ability*
Beginner - Assistance Required
Beginner - No Assistance Required
Intermediate
Advanced or Higher
Parent or Guardian's Email Address

Email*

Confirm Email*
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*

Emergency Contact's Relation to Participant
Health Care

This is crucial to know to give to Emergency Medical Services if a situation should arise.


Health Coverage (Alberta Health, etc.) *

Health Number (Coverage 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*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

FOOD ALLERGIES

COMMON DIETS

  • Gluten Free
  • Peanuts
  • Vegetarian
  • Dairy Free
  • Egg Free

Be as descriptive as possible regarding diets to help us serve you better.

1. Food Allergy

Rate the severity of your food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Food Allergy. Leave empty if not applicable.

2. Food Allergy

Rate the severity of your food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Food Allergy and required treatment practices if triggered. Leave empty if not applicable.

3. Food Allergy

Rate the severity of your food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Food Allergy and required treatment practices if triggered. Leave empty if not applicable.

NON-FOOD ALLERGIES (i.e. Medications, Animals/Insects, Seasonal Allergies, etc.)


1. Non-Food Allergy

Rate the severity of your non-food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Non-Food Allergy. Leave empty if not applicable.

2. Non-Food Allergy

Rate the severity of your non-food allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Non-Food Allergy. Leave empty if not applicable.

3. Non-Food Allergy

Rate the severity of the Non-Food Allergy. *
0 - No Allergy
1 - Minor Allergic Reaction
2 - Moderate Allergic Reaction
3 - Considerable Allergic Reaction
4 - Severe Allergic Reaction

What is the required treatment if the allergy is triggered? Leave empty if not applicable.

Describe the Non-Food Allergy and required treatment practices if triggered. Leave empty if not applicable.

MEDICAL CONDITIONS

Do you have any medical conditions?*
No
Yes

Clearly describe any medical conditions and any related concerns about your adventure experience. Leave empty if unapplicable.

MEDICAL HISTORY

Do you have any relevant past medical history such as injuries or surgeries?*
No
Yes

Clearly describe the past medical history including when it happened. Leave empty if unapplicable.

MEDICATIONS

Are you currently taking medications? (i.e Epipen, seasonal allergy meds, other)*
No
Yes

Clearly list the medications name, purpose and how often you take it. Leave empty if unapplicable.

SWIMMING ABILITY

Rate Your Swimming Ability*
Beginner - Assistance Required
Beginner - No Assistance Required
Intermediate
Advanced or Higher
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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