THE LEADING EDGE CHALLENGE COURSE
PARTICIPANT AGREEMENT
(Including assumption of risks, and agreements of release and indemnity)
All persons (including minors) using the Challenge Course must sign this agreement to participate.
Parents (or legal guardians – both referred to as “Parent”) of minor participants must also sign, to reflect their understandings and agreements, for themselves and on behalf of the minor. Please complete the front and the back of this document (including medical information) and return it to the Lead Facilitator or Challenge Course Manager.
In consideration of being allowed to participate in a Challenge Course program to be organized and conducted by Leadership On The Move, LLC (“LOTM"), the undersigned Participant and, if appropriate, Parent, acknowledges and agrees as follows:
The Challenge Course program involves a variety of activities including: warm-ups, games, group initiatives, low and high challenge course elements, and other rigorous adventure activities in a wooded outdoor setting, subject to the sometimes unpredictable forces of nature. The program exposes participants to certain risks, some of which are inherent to the activity – that is, without them the program would lose its value and appeal. Other risks exist, of course. I /we understand that, although measures have been taken in an attempt to manage the inherent and other risks of the program, participants may suffer physical injury and property loss and, in extraordinary cases, emotional trauma and even death. I/we have read or have otherwise been provided a description of the activities and risks of The Leading Edge Challenge Course program at Stony Ranch and understand those descriptions. I/we understand further that participation in the program and its activities is voluntary and no one will be required to participate unless he or she freely chooses to do so.
The undersigned Participant, if an adult, or Parent (parent, for himself or herself AND on behalf of the minor child participant) acknowledges and assumes all the risks of the program, inherent or otherwise and whether or not described above. If the participant is a minor, Parent has discussed the risks with the child, who understands them and wishes to participate in spite of them, as evidenced by his or her signature below.
Participant, if an adult, or Parent (parent, for himself or herself AND on behalf of the minor child participant) hereby releases and agrees to indemnify (that is, to protect and pay damages and costs, including attorneys fees) LOTM, it's officers, directors, employees, faculty, agents, members, and all other persons assisting in instructing, facilitating and conducting these activities (the “released parties”), with respect to all claims and liabilities of any nature, including claims of negligence, for property loss or damage and for personal injury and death, suffered by Participant or Parent arising in whole or part from participant’s enrollment or participation in the program.
Participant, if an adult, or parent, if Participant is a minor, agree further as follows:
Understanding that parts of the Challenge Course may be physically or emotionally demanding, Participant or Parent affirms that Participant is in good health and is not under a physician’s care for any condition not disclosed to LOTM in writing which might cause Participant to be a danger to himself or herself or to others. Participant or parent agree that any dispute with LOTM, if not otherwise resolved, will be submitted to mediation in Denton County, Texas; and that any suit filed by Participant or Parent will be filed only in Denton County and governed by the laws of the State of Texas (not including those laws which may apply the laws of another jurisdiction.)
Participant, or Parent, agree to pay all costs including attorneys fees incurred by a released party in defending a claim or suit if that claim is withdrawn or to the extent a court or arbitration determines that the released party is not responsible for the loss claimed by Participant or Parent.
If a portion of this agreement is deemed by a court of competent jurisdiction to be not enforceable, the remaining provisions of the agreement shall nevertheless remain in full force and effect.
DATE BIRTHDATE
PARTICIPANT (print name)
ADDRESS CITY ZIP
SIGNATURE
(All participants MUST sign, whether an adult or minor)
PARENT OR GUARDIAN ______(IF APPLICANT IS UNDER 18 YEARS OF AGE)
WITNESS SIGNATURE
(SOMEONE MUST WITNESS YOUR SIGNATURE)
RELEASE / WAIVER (continued)
MEDICAL INFORMATION
I understand participating in any physical activity may be dangerous. Because the inherent and other dangers of the Challenge Course Program activities may be enlarged by pre-existing medical conditions, and to assist the LOTM staff in identifying possible medical issues during an activity, we ask that the Participant, or the Parent of a minor participant, on behalf of that minor, provide the following medical information:
Please Initial if
Not Applicable
I am currently under a doctor's care for:______
______
I am currently taking the following medication(s):______
______
I am allergic to the following medication(s) or allergen(s):______
______
The following medical condition(s) might effect my participation ______
______
I, ______, hereby consent to first aid, emergency medical care and, if necessary, admission to an accredited hospital when necessary for executing such care, for treatment of injuries that I sustain while participating in any activity associated with The Leading Edge Challenge Course.
Signature: ______Date: ______
Physician’s Name: ______Phone: ______
If I am the Parent of a participating minor child, I agree that, if I cannot be reached in an EMERGENCY, the staff of LOTM may transport, hospitalize and otherwise secure medical treatment for my minor child for any injuries that might be sustain while participating in any activity associated with The Leading Edge Challenge Course.
Signature:______Date:______
(Parent or Guardian’s signature)
Parent/Guardian:______Date:______
(Please Print)
Phone No. where parent or guardian can be reached in case of an emergency (____) ______
PHYSICIAN’S NAME ______PHONE (___)______
(PLEASE PRINT)
***Photos may or may not be taken during your event by Leadership On The Move, please let us know if you do
not wish to be photographed. LOTM may or may not use photos for promotional or marketing endeavors.
Revised 01/12