Release and Acknowledgement of Risks and Personal Responsibility

Print Name: _____________________________ Initial: _______
Trip Title: _____________________________ Date: _______________

Although the instructors/volunteers/leaders of this class have taken reasonable steps to provide appropriate equipment and skilled staff so that I can enjoy this activity for which I may not be skilled, I acknowledge that this activity is not without risk. Certain risks cannot be eliminated without destroying the unique character of this activity. The same elements that contribute to the unique character of this activity can be causes of loss or damage to my equipment, accidental injury, illness, or in extreme cases, permanent trauma or death. The leaders do not want to frightened me or reduce my enthusiasm for this activity, but think that it is important for me to know in advance what to expect and to understand the inherent risks so that I can make an informed decision to participate. The following describes some, but not all of those risks.
This trip/class will be in a remote location with may be many days from medical facilities. Communication and transportation are difficult and sometimes evacuations and medical care may be significantly delayed. Meals are prepared over gas stoves and open fires. Water often requires disinfection before use. Camping hazards may include burns, cuts, diarrhea and flu-like illness, and falling timber.
Travel may occur by motor vehicle, raft, canoe, kayak, and other boats, swimming, aircraft, bicycle, bus, train, skis, foot, and by other means. Participants may travel over rugged unpredictable off-trail terrain, including boulder fields, downed timber, rivers, rapids, river crossings, high mountain passes, snow and ice, steep slopes, slippery rocks, steep crevassed glaciers, ocean tides and currents, waves and reefs. Attendant risks include, but are not limited to, collision, falling, capsizing, drowning and other risks typically associated with such travel, as well as environmental risks.
Environmental risks include, but are not limited to, rapidly moving, deep, cold water; insects, snakes, and predators, including large animals; falling and rolling rock; lightening, avalanches, flash floods, and unpredictable forces of nature, including weather with may change to extreme conditions without notice. Possible injuries and illnesses include hypothermia, frostbite, high altitude illnesses, sunburn, heatstroke, dehydration, and other mild or serious conditions.
Decisions are made by the leaders and participants in a wilderness setting, on the basis of a variety of perceptions and evaluations with by their nature are imprecise and subject to errors in judgment. Throughout the class/trip, participants are responsible for their own safety.
I have read and understand the trip information sheet provided. I am aware of the level of exertion required to participate in this class/trip. I have the necessary skills to participate in the activity as listed on the trip information sheet and I am fully capable of participating in this activity without causing harm to myself or others. I have verified with my physician and other medical professionals this I have no past or current physical or psychological condition that might affect my participation. I authorize the trip leaders or their representatives to obtain or provide emergency hospitalization, surgical or other medical care for me.
I acknowledge that this class/trip entails known and unanticipated risks, which could result in property damage, physical or emotional injury, paralysis, or death, to me, or others. I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activity. I expressly agree and promise to accept and assume all of the risks existing in connection with or arising out of my participation in this activity. My participation in this activity is purely voluntary. By signing below, I signify my informed consent to participate despite any risks.
Should the leaders or other participants, or anyone acting on their behalf, incur attorneys’ fees and costs in connection with my participation in the activity or this agreement, I agree to indemnify and hold such persons harmless for all fees and costs.
I certify that I have adequate insurance to cover any injury of damage I may cause or incur while participating, or else I agree I will be solely responsible to pay the costs of such injury or damage myself. I further certify that I have no medical or physical conditions that could interfere with my ability to participate in this activity, my safety or the safety of other or else I am willing to assume—and bear the costs of—all risks that may be created, directly or indirectly, by any such condition.
In consideration of my participation in this class/trip, I hereby voluntarily release, discharge and hold harmless the leaders, volunteers, and other participants, on the behalf of myself, my children, my heirs, assigns, personal representative, and estate for any and all claim, demands, or causes of action, which are in any way connected with my participation in this activity or my use of any equipment or facilities, including such claims with allege negligent acts or omissions of the organizers/leaders. I understand that signing this agreement I waive legal rights to which I may otherwise by entitled.
I have had sufficient opportunity to read this entire document and to secure legal counsel if I chose. I certify that I have read, understand, and agree to be bound by its terms. I understand and agree that this agreement shall be governed by and construed in accordance with the laws of the State of North Carolina, and any dispute hereunder shall be resolved in a North Carolina court of competent jurisdiction without regard to conflicts of laws.

Signature of Participant: ________________________________ Date: ________________

I have the following physical impairments or medical conditions, including allergic reactions: __________________________________________________________________________

Emergency Contact: ______________________ Phone: ____________________