Forms Heading

In order to participate, you must complete and return this form.

Activity Information

Participant Information

Medical and Insurance Information Yes No

Yes No


By clicking below, the participant (or parent / guardian if participant is a minor) acknowledges and accepts the risks of physical injury associated with participation in the activity described above. Except for gross negligence on the part of the sponsor, the participant (or parent / guardian) accepts personal financial responsibility for any bodily or personal injury sustained during the activity. Further, the participant (or parent / guardian) promises to hold harmless the sponsoring organization and its representatives for any injury related to the activity.

If a dispute over this agreement or any claim for damages arises, the participant (or parent / guardian) agrees to resolve the matter through a mutually acceptable arbitration process.

Do you agree with the terms and conditions?

Yes, I agree.