Orenda
Springs
Experiential Learning Center
Assumption of Risk, Waiver of Liability
Medical Authorization and Publicity Consent
Orenda Springs offers
adventure-based experiential learning activities at our center and at other
locations that may include but are not limited to: hiking, camping,
mountain biking, cross-country skiing, orienteering, low and high ropes course
elements, rock-climbing, horse activities, canoeing, and kayaking. These activities can be
physically demanding and offer inherent risks. I acknowledge and accept that
the nature and location of outdoor/wilderness activities can compound the difficulty of emergencies or delay
medical care. I accept responsibility for deciding if any pre-existing
medical condition should limit my participation in these activities. It is
not possible to anticipate all risks that could occur during this activity, but
I accept all risks that could cause injury and death. If I am
uncomfortable with engaging in any event or do not understand the instructions
for any event, I will inform a facilitator, and will not participate in that
event.
I, for myself and on behalf of my heirs,
assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY
AND HOLD HARMLESS Orenda Springs, their officers, officials, agents and/or
employees, other participants, sponsoring agencies, sponsors, advertisers, and
if applicable, owners and lessors of premises used to conduct the event
("Releasees"), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH,
or loss or damage to person or property, including claims arising from
transportation to and from the activity, to the fullest extent permitted by
law. I agree to pay all costs, legal expenses and adverse judgments
incurred by Orenda Springs for any claim or lawsuit that I may file or is filed
by anyone else on my behalf.
In the event of any suspected
injury or medical condition that requires immediate attention, I consent to
treatment by Orenda Springs and its facilitators. If treatment becomes
necessary, I agree to pay for any such treatment, including treatment received
from any other health care provider, and including the cost of transportation
to a medical facility.
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I acknowledge that Orenda Springs may
utilize photographs that may be taken of me or statements that I may make
during the activity for promotional or educational purposes. I consent to
this use and waive all rights to compensation. In consideration for
participation in this activity, I agree to the terms above. I understand
that this is a binding legal document.
If any part of this agreement is deemed
unenforceable, it is the intent of the parties herein that the remainder of the
agreement continue in full force and effect.
ParticipantŐs Name (print):
___________________________________Date: _________________
ParticipantŐs Signature:
______________________________________
Parent/Guardian Signature if under 18 years
of age: ________________________
Parent/Guardian Name (print):
___________________________
Address:__________________________________________ email:_______________________
Phone Numbers (Home)_______________
(Work)______________ (Cell) __________________
Name of Emergency Contact:
___________________________ Phone: _____________________
Medical conditions of participant (ex:
medications, allergies, asthma, heart, back problems, etc.)