Waiver

PARTICIPANT AGREEMENT, RELEASE AND ASSUMPTION OF RISK

 

            In consideration of the services of Wilderness Youth Project Incorporated,  I hereby agree, on behalf of myself and my employees, agents, representatives, guardians, successors, children, heirs, assigns, next of kin, personal representatives, and estate (the “Related Parties”), to release, indemnify, and discharge Wilderness Youth Project Incorporated, its agents, directors, officers, volunteers, participants, employees, independent contractors, and all other persons or entities acting in any capacity on its behalf or providing equipment, facilities, or property for its programs (hereinafter collectively referred to as “WYP“), as follows:

 

  1. I acknowledge that my participation in WYP’s outdoor adventure based programs, including but not limited to bike tours, rock climbing, hiking, camping, backpacking, sea kayaking, sailing or fishing, entails known and unanticipated risks that could result in physical or emotional injury, paralysis, death, or damage to myself, to property, or to third parties.  I understand that such risks may result from, among other causes, the active or passive negligence of WYP, including but not limited to negligent instruction or supervision by WYP.
  2. I expressly assume all of the risks that may result from my participation in WYP’s programs.  My participation in these activities is purely voluntary, and I elect to participate with knowledge of the risks.
  3. I hereby voluntarily release and indemnify WYP from all liability to me and the Related Parties for all claims, damage, demands, or causes of action for personal injury, death, or property damage, which are in any way connected with my participation in WYP’s programs or my use of WYP’s equipment or facilities.  This release includes, without limitation, any personal injury, death, or property damage caused by the active or passive negligence of WYP. I agree to bear sole responsibility for any loss.

  4. I understand and acknowledge that this release of liability applies to and includes all unknown or unsuspected consequences or results arising from or relating to my participation in WYP’s programs. I have read the contents of California Civil Code §1542, which says “A general release does not extend to claims which the creditor does not know or suspect to exist in his or her favor at the time of executing the release, which if known by him or her must have materially affected his or her settlement with the debtor.” I, for myself and my Related Parties, expressly waive any and all rights and benefits under California Civil Code §1542.

  5. Should WYP or anyone acting on their behalf be required to incur attorney’s fees or costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs.
  6. I certify that I have adequate insurance to cover any injury or damage I may cause or suffer while participating, or else I agree to bear the costs of such injury or damage myself. I further certify that I am willing to assume the risk of any medical or physical condition I may have.
  7. In the event that I file a lawsuit against WYP, I agree to do so solely in the state of California, and I further agree that the substantive law of that state shall apply in that action without regard to the conflict of law rules of that state. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect.         

 

By signing this document, I acknowledge that if anyone is hurt or property is damaged during my participation in this activity, I may be found by a court of law to have waived my right to maintain a lawsuit against WYP on the basis of any claim from which I have released them herein.

 

I have had sufficient opportunity to read this entire document.  I have read and understood it, and I agree to be bound by its terms.  I acknowledge that WYP is materially relying on this waiver in allowing me to engage in its programs.

 

Name of Participant _______________________________ 

If Participant is 18 years of age or older:

 

Signature of Participant _________________________  

 

Date:

 

If Participant is under 18 years of age:

 

I represent and warrant that the Participant is my child.  I am entering into this Participant Agreement, Release and Assumption of Risk on his or her behalf.  I represent and warrant that I have the legal authority to do so.  I further agree to release and indemnify WYP from any and all claims which are brought by or on behalf my child and which are in any way connected with his or her participation in WYP’s programs.

 

Name of Participant’s Parent: _________________________  

 

Signature of Participant’s Parent: _________________________  

 

Date:

 

 

                     

 

 

Wilderness Youth Project Medical Release Form

 

Media Release: I,____________________________________, hereby authorize Wilderness Youth Project to use my child’s image/likeness/voice in still photos, slides, video productions, voice recorded productions, radio coverage, television coverage and/or any other media for the purpose of promoting Wilderness Youth Project and its programs.

 

AUTHORIZATION TO CONSENT TO TREATMENT OF MINOR

 

I (We), the undersigned, parent(s) of ___________________________ a minor, do hereby authorize Wilderness Youth Project, as agents of the undersigned to consent to any x-ray, examination, anesthetic, medical or surgical diagnosis or treatment and hospital care which is deemed advisable by and is to be rendered under the general or special supervision of any physician or surgeon licensed under the provisions of the California Medical Practice Act, whether such diagnosis or treatment is rendered during a Wilderness Youth Project outing by said health care provider at the outing location, the provider’s office, a hospital, or other location.  This authorization also applies to dental care under a duly licensed dentist.  It is understood that this authorization is given in advance of any specific diagnosis, treatment, or hospital care being required but is given to provide authority and power on the part of our aforesaid agent(s) to give specific consent to any and all such diagnosis, treatment or hospital care which the afore mentioned physician in the exercise of his/her best judgment may deem advisable; and neither said agent or any organization involved assumes any financial responsibility for exercising this action.  The undersigned also releases Wilderness Youth Project, and its agent, from all claims which may develop or accrue to me, or the minor for whom this authorization is intended to benefit, on account of, or reason by of, any injury, loss, or damage which may be suffered by me or the minor as a result of the exercise of this consent, and I hereby assume and accept the full risk and danger of any injury; hurt or damage that may occur as a result of the use of exercise of this consent.  This authorization is given pursuant to the provision of Section 6910 of the Family Code of California and shall remain effective until revoked in writing and delivered to said agent(s).

 

Signed:                                                                         Date:

 

Print Name: 


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