49 North Rental/release Form

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49° NORTH RENTAL/RELEASE FORM
RENTAL RELEASE AGREEMENT
I have accurately represented the personal information on this form and it is true and correct. I
will not use any of the equipment to be provided to me during this transaction until I have
Date: ________________
received instruction on its use and I fully understand its use and function. I agree to verify that
the visual indicator settings to be recorded on this form for downhill ski equipment agree with the
Name: __________________________________________________________
numbers appearing in the visual indicator windows of the equipment to be listed on this form.
Last
First
MI
I accept for use as is the equipment listed on this form, and accept full financial responsibility for
the care of the equipment while it is in my possession. I will be responsible for the replacement at
Address: ________________________________________________________
full value of any equipment rented under this form, but not returned to the rental shop. I agree to
Street
return all rental equipment by the agreed date and time.
________________________________________________________________
I understand that the binding system cannot guarantee the user’s safety. In downhill skiing,
City
State
Zip
the binding system will not release at all times or under all circumstances where release may
prevent injury or death, nor is it possible to predict every situation in which it will release. In
snowboarding, telemark skiing, cross-country skiing and snowblade use, the binding system will
Phone #: ___________________________
not ordinarily release during use; these bindings are not designed to release as a result of forces
generated during ordinary operation.
I understand that the sports of skiing, snowboarding, telemark skiing, cross-country skiing,
snowblade use and other recreational activities involve inherent and other risks of injury and
death. I voluntarily agree to expressly assume all risks of INJURY or DEATH that may result
from skiing, snowboarding, telemark skiing, cross-country skiing, snowblade use, or relate in any
This section must be filled out completely
way to the use of this equipment.
If Renting Skis
If Renting Snowboard
I AGREE TO RELEASE The Ski Area, Chewelah Basin Ski Corp. dba 49 Degrees North, its rental
shop, its employees, its owners, affiliates, agents, officers, directors, and the manufacturers and
Circle one
Circle one
distributors of this equipment (collectively “PROVIDERS”), from all liability for injury, death, property
Skier type: I
II III
Left Foot Forward Right Foot Forward
loss and damage which results from the equipment user’s participation in the sport of skiing,
snowboarding, telemark skiing, cross-country skiing, snowblade use, or is in any way related to use
Regular
Goofy
See Skier Type Chart
of this equipment, including all liability which results from the NEGLIGENCE of PROVIDERS,
User’s Weight: _____ Height: _____ Age: _____ Shoe Size: _____
including but not limited to, negligence in the selection and/or adjustment of equipment, or any other
person or cause.
Mns/Wmns/Child
Y
N
Rental Insurance?
Add $3 to rental price - Covers damage of any type!
I further agree to defend and indemnify PROVIDERS for any loss or damage, including any
Y
N
that results from claims or lawsuits for personal injury, death, or which relate in any way to the
HELMET RENTAL
use of this equipment, the ski area and its facilities. This agreement is governed by the
applicable law of this state. If any provision of this agreement is determined to be unenforceable,
For Technician Use only
all other provisions shall be given full force and effect.
Boot Inv. #: __________Ski Inv. #: ______________
Pole: _________
PARENT/GUARDIAN: I verify that I am the parent or guardian of the minor, and I have
Sole length: ________
SC/IIS: _____ / _____
authority to enter into this agreement on behalf of the equipment user and I agree to be bound
by the terms and conditions of agreement. I further agree to indemnify and hold harmless the
RT ____
RH ____
LT ____
LH ____
Providers for any and all damage cost and claims arising from the minor’s use of equipment.
CONSENT TO MEDICAL TREATMENT OF MINORS
Boot Inv. # ____________
Snowboard Inv. #: ________________
I hereby authorize any duly authorized doctor, emergency medical technician, registered ski
patroller, hospital or other medical facility to treat any minor that is listed on the application form
STANCE
BOOT/BINDING
SCREWS/PARTS
LEASH
for the purpose of attempting to treat or relieve any injuries received while being transported to
TECH. INIT. __________________
or from 49°
NORTH SKI AREA or while at 49° NORTH SKI AREA. I authorize any licensed physician to
I HAVE READ AND UNDERSTAND THE RELEASE AND MEDICAL CONSENT AGREEMENTS. I
perform any procedure which he/she deems advisable in attempting to relieve any injuries
VOLUNTARILY AGREE TO THE TERMS OF THE RELEASE AND CONSENT AGREEMENTS.
and/or related unhealthy conditions of said minor that he/she may encounter during any
necessary operation.
________________________________________ Date___________
Participant’s signature
I consent to the administration of anesthesia as deemed advisable by any licensed physician.
________________________________________ Date___________
I realize and appreciate that there is a possibility of complications and unforeseen consequences
PARENT OR GUARDIAN SIGNATURE
in any medical treatment and I assume any such risk on the behalf of myself and said minor. I
acknowledge that no warranty is being made as to the results of any treatment. I also consent to,
and accept full financial responsibility for any form of emergency transportation and care deemed
appropriate by the 49° NORTH SKI PATROL.

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