LIABILITY WAIVER

RELEASE AND ASSUMPTION OF RISK AGREEMENT

I am aware and understand that participating in the Exploring Roots program has inherent risks, with potentially dangerous activities that have the potential for death, serious injury, and property loss. These risks include, but are not limited to, hazards of injury to my person or property while engaged in the Exploring Roots Outdoor Program. I hereby assume all risks of participating in Exploring Roots Outdoor Program.

I agree to wear any and all protective equipment needed for activities, such as harnesses, helmets, personal flotation devices, or other safety equipment. I agree to use proper safety equipment or I may not participate in the Exploring Roots Outdoor Program.

I certify that I am physically fit, have trained sufficiently for participation in this activity, and have not been advised otherwise by a qualified medical person. I am aware and understand the risks of participating in outdoor activities, such as ropes courses and zip lines, bouldering, climbing, camping, backpacking, hiking, fishing, canoeing, kayaking, swimming, caving, or other activities. I am aware and understand the risks of personal injury, accidents, and/or illness, include, but are not limited to sprains, strains, torn muscles, and/or ligaments; attacks or bites from animals and pests, such as ticks which may carry diseases, leeches, poisonous snakes, or other animals; fractured or broken bones; eye damage; cuts; wounds, scrapes, abrasions and/or contusions; dehydration, hypothermia, and/or oxygen shortage; head, neck, and spinal injuries; shock; paralysis or death; and serious injury or impairment to other aspects of my body and general health and well being.

I give permission for Exploring Roots to seek emergency medical service for me should I become injured or ill with the understanding that I am responsible for any and all expenses incurred. I fully understand that Exploring Roots does NOT provide any medical insurance coverage for me while participating in this program. I also realize that I may be attended by Exploring Roots personnel with emergency medical care that you might expect from an average person, until professional medical care is available, as Exploring Roots personnel and volunteers are not trained medical professionals.

I, do hereby for myself, my heirs, executors, administrators, successors, and assigns, indemnify and hold harmless, release, acquit, and forever discharge Exploring Roots, its employees, volunteers, board members, advisory board members, contracted agents, and insurers from any and every claim, demand, right, or cause of action, property damage, personal injury, cost, loss of service, expenses of any kind, and any compensation whatsoever, which I may ever assert by reason of my or my child’s present and/or participation in Exploring Roots Outdoor Program including any claims which might arise from natural, environmental, or weather conditions, and from the nature or condition or manufacturer or any structures or appurtenances on the premises, and further including any and all claims which might arise from any use of any equipment which might be attached to or near any structures or appurtenances on the premises, or used in conjunction with Exploring Roots instruction, and all claims which might arise out of the acts or omissions of other persons on the premises, whether directly connected with Exploring Roots programs or not.

Name of Participant *
Name of Participant
Name of Parent or Guardian if Applicable
Name of Parent or Guardian if Applicable
Your Phone Number *
Your Phone Number
Emergency Contact Name *
Emergency Contact Name
Signature (if over 18) or Legal Guardian (if under 18): By typing my name below I am agreeing to the above. *
Signature (if over 18) or Legal Guardian (if under 18): By typing my name below I am agreeing to the above.
Your Date of Birth for Verification *
Your Date of Birth for Verification