Zip Line Participation Waiver And Release Form (Page 2 of 2) in pdf

child against another co participant. These agreements of release and indemnity include loss or damage

caused or claimed in whole or in part by the negligence of a Released Party, but not intentional wrongs or

the gross negligence of a Released Party.

Initial here________

4. Severability

If any provision of this agreement is held to be void or otherwise unenforceable by a court of competent

jurisdiction, the remaining provisions shall nevertheless be fully enforceable and unimpaired by such

holding.

Initial here________

5. Additional Provisions

I, an adult participant or the parent/guardian of a minor participant, authorizes Mt. Holiday Mountain, Inc

Zip Line Tours to provide or obtain for me such medical care as it considers necessary and appropriate,

and I agree to pay all costs associated with such care and transportation. Any dispute between a

Released Party and participant or parent/guardian will be governed by the laws of the State of Michigan,

and any mediation or suit shall take place only in that State in the County of Clare or in the Federal Court

for the State of Michigan.

Initial here________

6. I, on behalf of myself and any minor children or child, hereby give my permission and consent to the

taking of photographs, video, or other media and agree that such material may be published and

otherwise used by Mt. Holiday Mountain, Inc. Zip Line Tours for purposes it deems appropriate without

compensation to myself or the child.

Initial here________

I the Undersigned understand and acknowledge that this Agreement is a contract and shall be binding

to the fullest extent permitted by law. If any part of this Agreement is deemed to be unenforceable, the

remaining terms shall be an enforceable contract between the parties. It is the Undersigned’s intent that

this Agreement shall be binding upon the assignees, subrogates, distributors, heirs, next of kin, executors

and personal representatives of the Undersigned.

Initial here________

I HAVE CAREFULLY READ AND FULLY UNDERSTAND THE PROVISIONS OF THIS AGREEMENT

INCLUDING MY WAIVER OF CLAIMS AGAINST MT. HOLIDAY MOUNTAIN, INC. ZIP LINE TOURS. I

HAVE NOT RELIED UPON ANY OTHER REPRESENTATION OR STATEMENT, WRITTEN OR ORAL.

Initial here________

The Mt. Holiday Mountain, Inc Zip Line Tour activity is designed for participants in reasonably good

health. Due to the nature of the tour, we reserve the right to refuse participation to anyone. The Mt.

Holiday Mountain, Inc Zip Line Tour activity is operated in an isolated environment, immediate medical

attention may not be available. We cannot be responsible for any valuables dropped from the tour or left

in your vehicle. You must sign the Voluntary Participation Agreement Form above prior to participation.

PLEASE PRINT. Leave no lines blank. List each Participant’s information individually and sign.

Participant’s Name: ________________________________ Birthdate:_________

Height:_______ Weight:_______lbs.

Address: ________________________________City:______________________ State:_______ Zip:___________

Cell Phone: ____________________________

Email: ________________________________________________

Participant’s Signature: ___________________________________________________ Date: _________________

Parent/Guardian Signature: ________________________________ Relation:________________ Date: ________

Emergency Contact: ________________________________________ Phone: ____________ Relation: _________

Medical considerations: ________________________________________________________________________

Zip Line Participation Waiver And Release Form Page 2

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