Participant Information And Waiver Form

Download a blank fillable Participant Information And Waiver Form in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Participant Information And Waiver Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.


Wheaton Park District, Lincoln Marsh Challenge Course
(Teams, High Ropes, Climbing Tower, Power Pole and Crate Stacking)
Participant Information & Waiver form
Program Date:________________________________ Group Name:__________________________________
First Name:__________________________________________ Last Name_____________________________
Street _________________________________________ City, State________________ Zip_______________
Phone (Home) ______________________________________ (work)_________________________________
Birthdate ___/___/___
M___ F___
Emergency Contact Name _________________________________ Relationship:________________________________
Emergency Phone # _________________________________________________________________________________
Medical information
Allergies ______________________________________ Injuries_____________________________________________
My child requires use of epi-pen
Yes No
Did they bring it today
Yes No
My child requires the use of an inhaler
Yes No
Did they bring it today
Yes No
Any other medical information we should be aware of: (ex: diabetes, epileptic, back problems, etc.)
The Wheaton Park District is committed to conducting its recreation programs and activities in a safe manner and holds the safety of participants in high regard. The Wheaton Park District
continually strives to reduce such risks and insists that all participants follow safety rules and instructions that are designed to protect the participants’ safety. However, participants and
parents/guardians of minors registering for this program/activity must recognize that there is an inherent risk of injury when choosing to participate in recreational activities/programs.
You are solely responsible for determining if you or your minor child/ward are physically fit and/or adequately skilled for the activities contemplated by this agreement. It is always advisable,
especially if the participant is pregnant, disabled in any way or has recently suffered an illness, injury or impairment, to consult a physician before undertaking any physical activity.
On Occasion, park district staff may photograph or videotape participants in park district classes/program or at park district facilities/events. These photos and videotapes are for park district
use only, and may be included in publications, brochures, pamphlets, flyers and videos.
The Lincoln Marsh Challenge Course is a series of challenging activities that engage the physical, mental and emotional resources of each participant. Despite careful and proper preparation,
instruction, medical advice, conditioning and equipment, there is still a risk of serious injury, including cervical spine injury and head/brain injury. Understandably, not all hazards and dangers
associated with the challenge course can be foreseen. Participants must understand that certain risks, dangers and injuries due to acts of god, inclement weather, slips and falls, insects,
defective equipment, failure in supervision or instruction, premises defects and other circumstances inherent to outdoor settings and recreational activities can exist. In this regard, it must be
recognized that it is impossible for the Wheaton Park district to guarantee absolute safety
Please read this form carefully and be aware that in signing up and participating in this program/activity, you will be expressly assuming the risk and legal liability and waiving and releasing
all claims for injuries, damages or loss which you or your minor child/ward might sustain as a result of participating in any and all activities connected with and associated with this
program/activity (including transportation services and vehicle operations, when provided).
I recognize and acknowledge that there are certain risks of physical injury to participants in the challenge course, and I voluntarily agree to assume the full risk of any and all injuries, damages
or loss, regardless of severity, that my minor child/ward or I may sustain as a result of participating in any and all activities connected with or associated with the challenge course.. I further
agree to waive and relinquish all claims I or my minor child/ward may have (or accrue to me or my child/ward) as a result of participating in this program/activity against the Wheaton Park
district, including its officials, agents, volunteers and employees here in collectively referred to as “Park District”. I do hereby fully release and forever discharge the park district form any and
all claims for injuries, damages or loss that my miner child/ward or I may or which may accrue to me or my miner child/ward and arising out of, connected with, or in any way associated with
the challenge course.
I have read and fully understand the above important information, warning of risk, assumption of risk and waiver and release of all claims. If registering on-
line or via fax, my on-line or facsimile signature shall substitute for and have the same legal effect as an original form signature.
Participant’s Name ____________________________________ Date: _______________________________________
Participant’s Signature ______________________________ Parent Signature: ___________________________________
(18 years or older or Parent/Guardian)
If the signature of adult participant or parent/guardian and date are not on this waiver.


00 votes

Related Articles

Related forms

Related Categories

Parent category: Legal