2019/2020 Primary Liability and Medical Information Form

Registering for Carrollwood Day School - 10/21/2019 10:00 AM - 10/23/2019 2:00 PM Change

ACKNOWLEDGMENT OF RISK, RELEASE FROM LIABILITY, INDEMNITY AND HOLD HARMLESS AGREEMENT

ACKNOWLEDGMENT OF RISK, RELEASE FROM LIABILITY,

INDEMNITY AND HOLD HARMLESS AGREEMENT

Pathfinder Outdoor Education, Inc. is a non-profit organization whose mission is to deliver fun and challenging adventures to help people learn about themselves, others and the environment. Pathfinder provides various environmental education, team building and outdoor based adventure activities. Pathfinder activities may include, but are not limited to, low challenge courses, high ropes, tree climbing and canoeing. Pathfinder’s activities often take place outdoors, and therefore participants may be involved in activities such as: traveling by vehicle, foot, in or near water, and near a campfire; encountering falling objects, including but not limited to, tree branches, ropes, boards, cables & other construction materials; encountering wild animals, insects, and plants; and may be exposed to the inclement weather including, but not limited to, rain, hail, storms, winds, and lightning. Before participating in any Pathfinder activity, each participant or, for those participants under the age of 18, their parent or legal guardian must complete this Acknowledgment of Risk, Release from Liability, Indemnity and Hold Harmless Agreement (hereinafter “Agreement”).

Section A. Release from Liability

In consideration of the opportunity to participate in the activities, undersigned clearly and unequivocally releases, waives, discharges and covenants not to sue Pathfinder Outdoor Education, Inc. and its affiliates, principles, directors, officers, agents, members, managers, employees and volunteers and any owners and lessees of the premises used to conduct the activity, for all purposes (hereinafter referred to as “Releasees), from all liability to the participant, undersigned, his/her personal representatives, assigned heirs, and next of kin for any and all claims, demands, actions and causes of action whatsoever arising out of or related to any loss, damage, injury, including death of the participant whether caused by the negligence of the Releasees or otherwise while the participant is in or upon the premises and/or for any purpose of participating in the activities.

Section B. Acknowledgment and Assumption of Risk

Participant is voluntarily participating in the activities and assumes full responsibility for the risk of bodily injury, death or property damage due to the negligence of the Releasees or otherwise, while in or upon the premises and/or while participating in the activities. The undersigned expressly acknowledges and agrees that the activities are very dangerous and involve the risk of serious injury and/or death and/or property damage.

Section C. Indemnity and Hold Harmless

Regardless of whether or not there is any applicable insurance, the undersigned shall release, indemnify, defend, and hold harmless the Releasees from all claims, suits, actions, demands, losses, damages, liabilities, costs, expenses (including, without limitation, attorneys’ fees), and causes of action of every kind or character whatsoever, whether in law or equity, in connection with any loss of life, bodily or personal injury, or damage to or loss of property arising from or out of any occurrence in, upon, at, or about the premises used to conduct the activity or any part thereof occasioned or caused in whole or in part, either directly or indirectly, by the act, omission, negligence, misconduct, the participant, his/her heirs, assigns, successors, executors, administrators, and legal representatives, or arising out of or relating to the participant’s participating in the activities. The Releasees shall not be liable or responsible for any loss or damage to any property or the death of or injury to any person requisition of other governmental body or authority, by other participants or by any other matter beyond the control of the Releasees. The undersigned’s obligations are not limited in amount, and specifically are not limited to the amount of any insurance. The indemnification set forth herein shall survive and continue in full force and effect and shall not be terminated, discharged or released in whole or in part for a period of two (2) years after the date of participation.

Section D. Medical Issues

The undersigned certifies that the participant has no mental, medical, or physical conditions which should interfere with my safety in this activity or is willing to assume and bear all costs of risk that may be created directly or indirectly by such a condition. The undersigned hereby authorizes medical treatment deemed necessary in the event of injury or illness to the participant for which the participant is responsible while partaking in any activity. Health/accident coverage is the responsibility of the participant or their parent/guardian.

The undersigned, on behalf of the participant, his/her heirs, assigns, successors, executors, administrators, and legal representatives, voluntarily accept responsibility for any expenses which may be incurred for illness or injury that may result in my participation including the cost of evacuation, hospitalization, medical treatment and any sums payable by anyone by any reasons of injury or loss of life that are sustained through participation in such activities and for all expenses associated with defense of such claims. The undersigned understands that this indemnification means that accepting responsibility for paying any costs including attorneys’ fees which may be due to claims made against the Releasees. 

Section E. – Minor Children’s Parent/Guardian Notice 

NOTICE TO THE MINOR CHILD’S NATURAL GUARDIAN
Read this form completely and carefully. You are agreeing to let your minor child engage in a potentially dangerous activity. You are agreeing that, even if Pathfinder Outdoor Education, Inc. and its affiliates, principles, directors, officers, agents,
members, managers, employees and volunteers (“Pathfinder”) use reasonable care in providing this activity, there is a chance your child may be seriously injured or killed by participating in this activity because there are certain dangers inherent in the activity which cannot be avoided or eliminated. By signing this form you are giving up your child’s right and your right to
recover from Pathfinder in a lawsuit for any personal injury, including death, to your child or any property damage that results from the risks that are a natural part of the activity. You have the right to refuse to sign this form, and Pathfinder has the right to refuse to let your child participate if you do not sign.

Section F. General Terms

The undersigned has read and voluntarily signs this Agreement, and further agrees that no oral representations, statement or inducements apart from the foregoing written agreement have been made. The undersigned agrees that this Agreement constitutes the entire agreement of the parties and supersedes any contracts, agreements, or understanding, oral or written, of the parties with respect to the subject matter hereof. The undersigned agrees that this Agreement shall be governed, bind, construed in accordance with the laws of the State of Florida without regard for conflict of law or rule of the state and that any legal action arising out of my participation in the activities shall be filed in Pinellas County, Florida. The undersigned further expressly agrees that this Agreement is intended to be as broad and inclusive as permitted by the Laws of Florida in which the activity is conducted and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

I HAVE HAD THE SUFFICIENT OPPORTUNITY TO READ THIS ENTIRE DOCUMENT AND I HAVE CAREFULLY READ AND UNDERSTOOD IT AND AGREE TO BE BOUND BY ITS TERMS. 

Who will be participating?

Adult    Children

Adult (18+) participants or Parent / Guardian Information

Other than parent/guardian

e.g. medications, red ants, bees, etc.

e.g. specific food allergies, specific dietary preferences or needs, religious considerations, etc.

e.g. asthma, disabilities, specific fears, previous injuries, foreign language, etc.

e.g. Epi Pen/Ana Kit

The undersigned consents to the use of the participant’s image by the Releasee for any and all purposes, including without limitation or compensation, video and still photography, or publication for any trade or advertising purposes providing such uses are not made as to constitute a direct endorsement of any product or service.

Please sign below using your mouse.

By clicking 'I Agree' below, you agree that you have read and agree with the terms of the waiver and that the information you provided is accurate. You furthermore agree that your submission of this form, via the 'I Agree' button, shall constitute the execution of this document in exactly the same manner as if you had signed, by hand, a paper version of this agreement.