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Waiver Form |
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| Assumption
of Risk: Outdoor activities and Adventure Racing often take
place in the wilderness and away from professional medical help. I,
the undersigned, voluntarily agree to participate in Adventureheads
activities, including but not limited to: races, training outings,
clinics, etc, coordinated by the Adventureheads Adventure Racing
Club. I understand this activity will have MORE inherent risks than
normal day-to-day activity. These risks can involve serious injury
or even death. I am freely and voluntarily participating in this
activity with the knowledge of the danger(s) involved and agree to assume
and accept any and all risks. I hereby agree that I will listen
carefully and follow all verbal and/or written instructions and directions
and ask questions if I do not understand.
I agree to refrain from the use of alcohol or any unprescribed drugs while voluntarily participating in the activity. I have thoroughly read this form and fully understand its contents
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| By signing this form I release all parties who planned, accompanied me, and or had any part whether through use of property, both land or equipment or had any association at all with this event from liability. I further certify that I am 18 years of age and understand that I am participating in this event at my own risk, which may cause personal injury or death. | |||||||||
| Date:
_____________________________________________________________________ Print Name: _____________________________________________________________________ Signature: _____________________________________________________________________ Emergency Contact Name: _________________________________________________________ Emergency Contact Phone: _________________________________________________________ |
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| Are you taking any medication that may be needed during the course of this event? ______ Yes _____ No If yes please specify: ______________________________________________________________ _______________________________________________________________________________ Known Allergies: _________________________________________________________________ Have you had any serious injury in the past year which may hinder your performance during this event? ______ Yes ______ No If yes please specify: ______________________________________________________________ _______________________________________________________________________________ Mail form to: Adventureheads, C/O Tom Wagar, 160 Plantation Ct, E Amherst, NY 14051 |
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