Participation And Hold-Harmless Agreement Form - All-Terrain Vehicle (Atv) Program

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All-Terrain Vehicle (ATV) Program
Participation and Hold-Harmless Agreement
Camp _________________________________________________________________________________________
Camp _______________________________________ from the ______________________________ Council will be conducting an
ATV program at camp. Scouts will be instructed how to ride on and drive an ATV. Scouts will be taught ATV safety and will drive
on a training course, then on approved trails only. Scouts will be on the unit individually and in control of the power and brakes.
Scouts will be required to wear a helmet, goggles, gloves, over-the-ankle boots, long-sleeve shirts, and long pants. Scouts are
expected to abide by all safety rules and the instructions of the camp instructor(s).
I, the undersigned, give my child, ________________________________, permission to participate in this program. I understand
that participation in the activity involves a certain degree of risk. I have carefully considered the risk involved and have given
consent for my child to participate in the activity. I understand that participation in the activity is entirely voluntary and requires
participants to abide by the rules and standards of conduct. I release the Boy Scouts of America, the ATV Safety Institute, the
local council, the activity coordinators, and all employees, volunteers, related parties, or other organizations associated with the
activity from any and all claims or liability arising out of this participation.
For safety, my child and I agree that he/she will do the following or he/she will be removed from the program. Because
space is limited, any additional cost associated with participation in this program will not be refunded.
1. Complete the ATV safety class taught at Camp __________________________.
2. Wear all required safety gear at all times on or around the equipment.
3. Follow all safety rules provided in the training class.
4. Follow the instructions of the camp staff instructor(s).
5. Maintain control of the ATV at all times and remain within the speed determined to be safe by the camp instructor(s).
6. Be in full compliance with all local, state, and federal guidelines, including age restrictions and original equipment
manufacturer standards.
7. Respond to the camp satisfaction survey from the Boy Scouts of America as it evaluates the ATV program.
Participant’s signature: _________________________________________________________ Date: _______________________________
Parent/guardian signature: ______________________________________________________ Date: _______________________________
Parent/guardian printed name: __________________________________________________ Date: _______________________________
Home phone: _________________________________________________________________ Cell phone: _________________________
Email address (for survey purposes only): _____________________________________________________________________________
430-048
2012 Printing

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