Age

RELEASE FORM

 
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Group Info

Participant Info

Birthday

Participants under 21 years of age require a parent/guardian consent.

Please enter the first and last name of the parent/guardian.

Camper’s Acknowledgment of Risk

There are significant elements of risk in any adventure, sport, activity or training associated with trekking, hiking, mountaineering, walking on glaciated terrain or surfaces (referred to herein as “activity”), and the use of any equipment. In consideration of the services of TABLE IN THE WILDERNESS MINISTRIES, their officers, agents, and employees, and all other persons or entities associated with this business (herein collectively referred to as the “concessionaire”), I agree as follows: Although the concessionaire has taken reasonable steps to provide you with appropriate equipment and/or skilled guides so you can enjoy an activity for which you may not be skilled, we wish to remind you that this activity still has risks. Certain risks cannot be eliminated without destroying the unique character of the activity. The same elements that contribute to the unique character of the activity can be causes of loss or damage to your equipment, or accidental injury, illness or in extreme cases, permanent trauma or death. We do not want to frighten you or reduce your enthusiasm for this activity, but we do think it is important for you to know in advance what to expect, and to be informed of the inherent risks. The following describes some, but not all, of those risks.

• Falls;

• Heat related illnesses including heat exhaustion and heat stroke;

• River crossings, fording, or travel including travel to or from the activity;

• Risk associated with crossing, climbing, or down climbing rock snow, and/or ice;

• Impaired sense of balance, physical coordination, and ability to follow instructions, and the actions of other climbers;

• Cold weather related injuries including hypothermia and frostbite, which may result in loss of limbs, digits, and/or permanent scarring;

• Altitude related sicknesses including acute mountain sickness, pulmonary edema, cerebral edema and or retinal hemorrhage;

• Avalanche, rock fall, crevasse fall, inclement weather, high winds, and severe cold;

• Equipment failure;

• Accidents or illnesses occurring in remote places where there are no available medical facilities.

Please review each statement and initial that you have read and acknowledge.

I acknowledge that activities entail risks of injury or death to myself. 

I, further, acknowledge and understand the description of the described risks is not complete and that other unknown or unanticipated risks may result in injury, illness, or death. 

I agree to assume responsibility for the risks identified herein and those risks not specifically identified. 

My participation in any activity is purely voluntary and no person/individual is forcing me to participate, and I elect to participate in spite of these risks.

I possess at least the following qualifications, which I understand are prerequisites to participate in this activity:

I am/my child is physically and mentally capable of participating in any activity and/or using any equipment.

I am/my child is safety conscious and acknowledge that wearing a UIAA approved helmet may be a basic safety precaution with respect to preventing head injury while rock climbing, rock face climbing, or rappelling.

I/my child acknowledge that if, during any activity, I/my child experience fatigue, chill, and/or dizziness, my/my child's reaction time may be diminished and the risk of accident will increase. Therefore, I assume full responsibility for myself, including any minor children for which I am responsible, for bodily injury, accidents, illness, death, loss of personal property, and expenses thereof as a result of those inherent risks and dangers, and of my/my child's negligence while participating in any activity.

I have read, understood, and accepted the terms and conditions stated herein and acknowledge that this agreement shall be binding upon myself, my heirs, assigns, personal representative, and estate, and for all members of my family including any minors accompanying me.

DISCLAIMER: By typing your name below, you are signing this release electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.  By signing this release form, I declare that I am doing so only for myself and/or the participant listed above for whom I am authorized. If I execute this release on behalf of another person, I understand and agree that I am acting as the agent for that person and my signature expressly confirms that I have permission to sign on the other person's behalf, and this release shall be binding upon that person.  I agree to defend, indemnify and hold harmless Table in the Wilderness as fully set forth above. In situations where an underage participant signs on their own behalf instead of a parent/guardian, the release will still be enforceable as Table in the Wilderness has no ability to confirm age/identity of the individual signing the release prior to participating in activities.  Lastly, in situations where a participant failed to complete and sign a waiver, participation in any activity at Table in the Wilderness constitutes a willing acceptance of the terms and conditions set forth within this release form.

Media Release

I understand that Table in the Wilderness Camp reserves the right to use any audio, video and/or photographs of any camper or guest participating in any Table-facilitated event for promotional or marketing purposes.

Special Dietary Needs Request

For our guests that have special dietary needs, we will do our best to provide some alternative
options at mealtimes. However, we cannot guarantee that food items will be free of cross
contamination from foods that may contain allergens such as gluten, nuts, and/or dairy. While
we will try and accommodate some common allergies (ie. gluten, dairy, nuts), we unfortunately cannot accommodate severe food allergies.

We do invite those with any severe food allergies to bring their own pre-prepared foods. Food is
not allowed in cabins so guests may use kitchen coolers, refrigerator space, and/or microwaves
when requested 10 days in advance. Kitchen stoves and prep areas will not be available.

Please note that food preferences cannot be accommodated unless there is a health reason such as an allergy or sensitivity that would cause illness or discomfort.

Check the appropriate box(es) below:

Email Address to send confirmation of receipt

Thank you for submitting the release form

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