PARTICIPANT AGREEMENT, RELEASE AND ASSUMPTION OF RISK
In consideration of the services of Equinox Guiding Service LLC, their agents, owners, officers, volunteers and all other persons or entities acting in any capacity on their behalf (hereinafter collectively referred to as "EGS"), I hereby agree to release, indemnify, and discharge EGS, on behalf of myself, my spouse, my children, my parents, my heirs, assigns, personal representative and estate as follows:
1. I acknowledge that my participation in guided and unguided hiking, Ice climbing, mountaineering, and rock-climbing 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. I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activity.
The risks include, among other things: slips and falls; falling objects; flying debris; rugged terrain; weather conditions; water hazards; accidents involving other bicycles or vehicles; collision with fixed or movable objects; injuries or accidents involving contact with or falls from the bicycle; major injuries are a risk as are sprains, strains, scratches, bruises, abrasions, cuts, lacerations, broken bones, fractures, musculoskeletal injuries including head, neck, and back injuries; injuries to internal organs; rope burns; belay failure; loss of fingers or other appendages; exhaustion; exposure to temperature and weather extremes which could cause hypothermia, hyperthermia (heat related illnesses), heat exhaustion, sunburn, dehydration; and exposure to potentially dangerous wild animals, insect bites, and hazardous plant life; exposure to altitude and cold including hypothermia, frostbite, acute mountain sickness, cerebral and pulmonary edema; hidden obstacles by snow including crevasses, ice and snow cornices, tree wells, tree stumps, creeks rocks and boulders, below the snow surface; loss or damage to equipment being used; equipment failure and/or operator error; improper lifting or carrying; being lost or separated from their guides or companions; the negligence of participants, or other persons who may be present; accidents or illness can occur in remote places without medical facilities and emergency treatment or other services rendered; transmissible pathogen or disease; traveling to and from activity locations raises the possibility of any manner of transportation accidents; my own physical condition, and the physical exertion associated with this activity; the condition of roads, terrain, or highways and accidents connected with their use.
Furthermore, EGS personnel have difficult jobs to perform. They seek safety, but they are not infallible. They might be unaware of a participant's fitness or abilities. They might misjudge the weather or other environmental conditions. They may give incomplete warnings or instructions, and the equipment being used might malfunction.
I expressly agree and promise to accept and assume all of the risks existing in this activity. My participation in this activity is purely voluntary, and I elect to participate in spite of the risks. Additionally, I agree to wear a properly fitted and secured helmet while participating in this activity as deemed necessary.
I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless EGS from any and all claims, demands, or causes of action, which are in any way connected with my participation in this activity or my use of EGS’s equipment or facilities, including any such claims which allege negligent acts or omissions of EGS.
Should EGS or anyone acting on their behalf, be required to incur attorney's fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs.
I certify that I have adequate insurance to cover any injury or damage I may cause or suffer while participating, or else I agree to bear the costs of such injury or damage myself. I further certify that I am willing to assume the risk of any medical or physical condition I may have.
In the event that I file a lawsuit against EGS, I agree to do so solely in the state of Maine, and I further agree that the substantive law of that state shall apply in that action without regard to the conflict of law rules of that state. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining document shall remain in full force and effect.
By signing this document, I acknowledge that if anyone is hurt or property is damaged during my participation in this activity, I may be found by a court of law to have waived my right to maintain a lawsuit against EGS on the basis of any claim from which I have released them herein. I also agree that this document is valid for subsequent visits and participation at EGS. I have had sufficient opportunity to read this entire document. I have read and understood it, and I agree to be bound by its terms.
Print Name
Address
State
Signature of Participant
Zip Email
DOB __Phone Number _ City
Date
PARENT'S OR GUARDIAN'S ADDITIONAL INDEMNIFICATION (Must be completed for participants under the age of 18)
In consideration of the following minor(s): (print name(s)and DOB(s))
being permitted by EGS to participate in its activities and to use its equipment and facilities, I further agree to indemnify and hold harmless EGS from any and all claims which are brought by, or on behalf of minor(s), and which are in any way connected with such use or participation by minor(s).
Parent or Guardian: Print Name: Date:_______________
VISITOR’S ACKNOWLEDGEMENT OF RISKS
In consideration of the services of Equinox Guiding Service LLC their officers, agents, employees, and stockholders, and all other persons or entities associated with those businesses (hereinafter collectively referred to as (EGS) I agree as follows:
Although EGS has taken reasonable steps to provide me with appropriate equipment and skilled guides so I can enjoy an activity for which I may not be skilled, EGS has informed me this activity is not without risk. Certain risks are inherent in each activity and cannot be eliminated without destroying the unique character of the activity. These inherent risks are some of the same elements that contribute to the unique character of this activity and can be the cause of loss or damage to my equipment, or accidental injury, illness, or in extreme cases, permanent trauma or death. EGS does not want to frighten me or reduce my enthusiasm for this activity, but believes it is important for me to know in advance what to expect and to be informed of the inherent risks. The following describes some, but not all, of those risks.
The risks include, among other things: slips and falls; the hazards of walking on uneven terrain; being struck by rockfall, icefall or other objects dislodged or thrown from above; the use of climbing ropes and equipment which could result in rope burns; pinches, scrapes, twists and jolts, scratches, bruises, sprains, lacerations, fractures, concussions, or even more severe life-threatening hazards; the risk of falling off the rock, mountain or into a crevasse; major injuries are a risk as are musculoskeletal injuries including head, neck, and back injuries; exposure to the elements of the outdoors which could cause hypothermia, hyperthermia (heat-related illnesses), heat exhaustion, acute mountain sickness, cerebral and pulmonary edema, hypoxia, sunburn, or dehydration; exposure to potentially dangerous wild animals, insect bites, and hazardous plant life; being lost or separated from their guides or leaders; equipment failure; the negligence of participants, members, or other persons who may be present; accidents or illness can occur in remote places without medical facilities; consumption of food or drink; transmissible pathogen or disease; improper lifting or carrying; my own physical condition, and the physical exertion associated with this activity.
I am aware that guided hiking, camping, backpacking, rock climbing, and mountaineering activities entail risks of injury or death to any participant. I understand the description of these inherent risks is not complete and that other unknown or unanticipated inherent risks may result in injury or death. I agree to assume and accept full responsibility for the inherent risks identified herein and those inherent risks not specifically identified. My participation in this activity is purely voluntary, no one is forcing me to participate, and I elect to participate in spite of and with full knowledge of the inherent risks.
I acknowledge that engaging in this activity may require a degree of skill and knowledge different than other activities and that I have responsibilities as a participant. I acknowledge that the staff of EGS has been available to more fully explain to me the nature and physical demands of this activity and the inherent risks, hazards, and dangers associated with this activity.
I certify that I am fully capable of participating in this activity. Therefore, I assume and accept full responsibility for myself, including all minor children in my care, custody, and control, for bodily injury, death or loss of personal property and expenses as a result of those inherent risks and dangers identified herein and those inherent risks and dangers not specifically identified, and as a result of my negligence in participating in this activity.
I have carefully read, clearly understood and accepted the terms and conditions stated herein and acknowledge that this agreement shall be effective and binding upon myself, my heirs, assigns, personal representative and estate and for all members of my family, including minor children.
Print Name
Address
State
Signature of Participant
DOB_____________Phone Number City
Zip Email
Date
Signature of Parent of Guardian, if participant is under 18 years of age ______________________________________ ____________________ Signature Date
Medical History Form
Participant’s Name_____________________________________ DOB___________ Sex_______Ht_______Wt_______ Address___________________________________________________________________________________________ Home Phone__________________________ Work__________________________ Cell__________________________ Parent or Guardian (if under 18)________________________________________
Home Phone__________________________ Work__________________________ Cell__________________________ Emergency Contact (someone who is not participating in the program)
Name________________________________ Relationship____________________ Phone________________________ Physician____________________________________________________________ Phone________________________ Insurance____________________________________________________________ Policy #______________________
Allergies___________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________
Medications________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________
Do you currently have or do you have a history of (check all that apply)
___Asthma ___Diabetes ___Headaches/Migraines ___Stomach Problems ___High/Low Blood Pressure
___Cardiac Problems
___Head Injury/loss of consciousness
___Epilepsy/Seizures
___Other, Please Explain:________________________________________________________________
Any additional medical notes, or causes for concern_____________________________________________________
By signing, I hereby agree that all of the above questions are accurately and completely answered, to the best of my knowledge. I recognize that withholding any medical information could endanger myself and other participants.
I hereby authorize medical assessment and treatment, emergency transport, evacuation procedures, and hospitalization as deemed necessary by my group’s guide or program coordinator.
I hereby understand that the cost for my medical treatment, emergency transport, evacuation, hospitalization, and any other costs that may relate to an injury will not be covered by Equinox Guiding Service or any of its owners, employees, or associates.
Participant’s Name________________________________________________________________________________Signature_______________________________________________________________ Date_____________________ Parent or Guardian if under 18 (please print) ________________________________________________________ Signature of Parent or Guardian if under 18 _______________________________ Date____________________
___Arthritis ___Bleeding/Blood disorders ___Chest Pain ___Pacemaker ___Neurological Problems
___Treatment for Menstrual Cramps
___Recent Illness/Surgery ___Dizziness/Light Headedness