Release Of Liability / Assumption Of Risk Form (Page 2 of 7) in pdf

Petra Cliffs Mountaineering School

Release of Liability / Assumption of Risk Form

Program:

Date:

_____________

Adventure-based activities are exciting, challenging, and physically and emotionally demanding. Our Instructors are trained to supervise

these activities in a safe manner by both Charest Alpinism LLC veteran instructors and by accredited outside training programs.

Acknowledgment of Risk

While the staff and student leaders aim to provide you with a safe arid enjoyable experience, you must realize that there is a certain

degree of risk inherent in these adventurous activities when you participate. Furthermore, there are significant hazards involved in any

adventure sport, or activity associated with the outdoors or involving physical exertion and risk-taking and the use of related equipment

for the activity. Including but not limited to the following:

Land Sports such as Challenge Courses, Rock and Ice Climbing, Mountaineering, Hiking, Skiing and Snowshoeing:

Hazards include but are not limited to twisting an ankle, breaking a bone, sustaining a head or neck injury or other serious physical

injury; acts of nature such as rock fall; varying weather conditions such as severe heat or cold.

Water Sports such as canoeing, Kayaking, white water rafting, Fishing, and water rescue:

Hazards include but are not limited to rowing, changing water levels or current, submerged or partially exposed objects; foot

entrapments; severe weather conditions such as sever heat and cold.

I will be instructed in safe practices to participate in these activities and will not be asked to participate in a manner that is unreasonable

or imprudent. However, the instructor cannot guarantee absolute safety. Consequently, I must recognize and accept shared

responsibility for my safety and the safety of other group members. I will ask questions if I do not understand the instructions and

guidelines. I will also obey all rules and guidelines at all times.

Release of Liability

In consideration of the services and or equipment provided, I, for myself and any minor children for which I am a parent or legal

guardian or otherwise responsible, any heirs, personal representatives, or assigns, do hereby release Charest Alpinism LLC, its

principles, directors, officers, agents, employees, volunteers from all liability; and waive any claim for damage arising from any cause

whatsoever in any way connected to this activity.

Authorization

I hereby authorize any medical treatment deemed necessary in the event of receiving any injury while participating in the activity. I

agree that any film or photographs of me/us as participants become your property and may be used for promotional purpose.

BY SIGNING THIS REALEASE OF LIABLITY FORM, I ACKNOWLEDGE THAT I HAVE READ THIS DOCUMENT, I FULLY

UNDERSTAND ITS CONTENTS, AND FREELY ACCEPT THE LIMITATIONS ON MY RIGHTS SET FORTH IN THIS RELEASE OF

LIABILITY.

Signature:

Print Name:

Date:

Street Address:

City:

State:

Zip:

Home Phone:_________

____ ____

Cell Phone:

Emergency Phone:

Emergency Contact Name:

Date of Birth:

E-mail Address:

TO BE READ AND SIGNED BY PARENT/LEGAL GUARDIAN OF MINORS.

I hereby state that I am the parent or legal guardian of the minor whose signature appears above. I have read, understand and freely accept the terms

and provisions set forth in this release. If a minor does not have a signed release of liability form from a parent/guardian Charest Alpinism LLC can

refuse to let that minor climb, or at its option, agree to let the minor climb, but that it does so only because the undersigned party herby agree to full

responsibility for the safety of that minor under the terms of this release of liability.

Signature of Parent or Guardian_________________________Print Name:__________________Date:______________

Petra Cliffs Mountaineering School

105 Briggs Street

Burlington, VT 05401

(802) 657-3872 Toll-free: (866) 657-3872

Fax: (802) 657-3877

Release Of Liability / Assumption Of Risk Form Page 2

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