2020 Wasatch Mountain Guides LLC Trip Registration Form

Wasatch Mountain Guides LLC

TRIP REGISTRATION FORM
Dear Adventurer,

Firstly, WELCOME ABOARD! Here at Wasatch Mountain Guides, our expert team have dedicated their lives to the mountains, and chosen the Wasatch Range as their home ... for good reason! We just can't wait to share the breathtakingly beautiful and wild Wasatch mountains with YOU. Meanwhile, we require just a couple quick tasks to complete your registration.... Our sign up process is quick and easy. 1) Fill in the information requested here and sign the Acceptance of Risk on the second page 2) Send in your payment
Name of your program: *
Please add the start date of your program here (use format MM-DD-YYYY) *

Month Day Year
Please describe your outdoor/ski and/or mountaineering experience, particularly as it is relevant to the program for which you are registering. This information will help your instructor and guide address your individual interests and goals as effectively as possible. *
Skills interested in learning or goals for the day: *
Personal Information
Name *

First Name Last Name
Preferred Name *
Your address for your invoice *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Your Email *
example@example.com
Your Cell Phone Number *

Area Code Phone Number
Date of birth (use format MM-DD-YYYY)

Month Day Year
Date
Your height and weight *
An Emergency Contact
Name *

First Name Last Name
Relation to you *
Emergency Contact Phone *
Emergency Contact Second Phone

Area Code Phone Number
Physical Questionnaire

Please note that Wasatch Mountain Guides LLC reserves the right to refuse service at the participant’s expense due to misrepresentation of medical information. Your medical information will be shared with your guide to assist with any health issues while on your expedition. This information is requested for use in the event of an injury or emergency.
Please describe any physical limitations, or medical or physical condition(s) that might affect your ability to fully participate in the climb or course you have registered for *
Describe any known allergies to food, medications, bee stings, or asthma, anaphylaxis/allergies (do you carry an EpiPen?), as well as known diagnoses such as diabetes, heart disease, or previous stroke or seizures? Please also note any medications you take on a daily basis and be sure to bring your medications on your program *
Do you have any specific dietary needs or concerns? *
Please add any concerns:
By submitting this form I agree that the above information is true and correct.
Today's date (use format MM-DD-YYYY) *

Month Day Year
Date
Participant's Initials *
Co-sign - PARENT'S OR GUARDIAN'S ADDITIONAL CONFIRMATION OF CORRECT INFORMATION (Must be completed for participants under the age of 18)
Enter the message as it's shown *
Wasatch Mountain Guides

WMG GENERAL BOOKING TERMS AND CONDITIONS
Payments and Cancellations

Wasatch Mountain Guides LLC requires a 20% down payment to secure your reservation. Changes/cancellations can be made by phone or email up to 5 business days before the trip but must be acknowledged by the WMG office, by email. Final payment in full is due before trip departure.

If you cancel 5 (or less) business days before your trip’s start date, a credit will be issued for the amount of your deposit, but no refund of your deposit is available. Credits must be used within 18 months days from the original start date.

No date changes can be made within 5 business days of the start of the trip or course.

WMG reserves the right to cancel a trip due to lack of sign-ups, or other factors beyond our control. In this case, you will have the option of receiving a full refund or credit or rescheduling for a later date. WMG is not responsible for additional expenses incurred, including non-refundable airline tickets, equipment, lodging, and other travel-related expenses.

Changes to a trip itinerary made by our guides for any reason do not constitute a cancellation, and no refunds will be made in this case.

Safety and Participant Responsibility

Participants have responsibilities to themselves, Wasatch Mountain Guides LLC and to each other. They must choose the trip that is appropriate for their interests and skill level. Good physical condition is important on all Wasatch Mountain Guides LLC and is a prerequisite for participation. Proper trip preparation includes, but is not limited to, acquisition of the proper equipment, understanding the trip's itinerary, and familiarity with proper wilderness etiquette.

The activities you engage in during your program may require a degree of skill and knowledge different than other activities that you have participated in and you have a responsibility as a participant to be in optimal physical condition and health. You are voluntarily participating in these activities with knowledge of the potential dangers involved, as well as the knowledge that some dangers are unforeseeable and uncontrollable, and the knowledge that these dangers exist no matter your physical and mental preparedness.

You must follow all instructions given by WMG and your guide without question, even if you do not agree with those instructions. On a trek or expedition, our guides reserve the right to remove any person from a trip for any reason. These reasons include jeopardizing the safety of yourself or another team member or physical inability to climb at the level necessary for the chosen route. If your guide removes you from a program, you will not receive any refund and you will be responsible for any additional costs incurred in leaving the trip.

Insurance

We recomend that all participants carry rescue insurance.
I have read and understood the WMG Terms and Conditions above
Today's date (use format MM-DD-YYYY) *

Month Day Year
Date
Participant's Initials *
Please review, then continue to Page 2

To sign our Acceptance of Risk Form

WASATCH MOUNTAIN GUIDES LLC

ACCEPTANCE OF RISK
In consideration of the services of Wasatch Mountain Guides LLC, their officers, agents, employees, and stockholders, and all other persons or entities associated with those businesses (hereinafter collectively referred to as (“WMG”) I agree as follows:

I am aware that outdoor based activities including but not limited to mountaineering, skiing, climbing, rappelling, and guided rock-climbing activities conducted on National Forest System (NFS) lands, entail risks of injury or death to any participant. I understand the description of these inherent risks is not complete and that other unknown or unanticipated inherent risks may result in injury or death. I agree to assume and accept full responsibility for the inherent risks identified herein and those inherent risks not specifically identified. My participation in this activity is purely voluntary, no one is forcing me to participate, and I elect to participate in spite of and with full knowledge of the inherent risks.

The risks include, among other things: slipping and falling; loss or damage to equipment being used; being lost or separated from their guides or companions; the hazards of walking on uneven terrain; being struck by rock fall, icefall or other objects dislodged or thrown from above; the use of climbing ropes and equipment; rope burns; pinches, scrapes, twists and jolts that could result in scratches, bruises, sprains, lacerations, fractures, concussions, or even more severe life threatening hazards; the forces of nature, including lightning, weather changes and avalanches; weather and altitude can be extreme and can change rapidly without warning; the risks of falling off the rock or mountain; exposure to the elements of the outdoors and natural surroundings which could cause hypothermia, hyperthermia (heat related illnesses), heat exhaustion, heat stroke, sunburn, frostbite, frost nip, dehydration, acute mountain sickness, cerebral and pulmonary edema; exposure to potentially dangerous wild animals, insect bites, and hazardous plant life; the negligence of other participants or people who may be present; travel in remote areas with poor or no access to emergency and/or medical services; my own physical condition, and the physical exertion associated with this activity.

I certify that I am fully capable of participating in this activity on NFS lands. Therefore, I assume and accept full responsibility for myself, including all minor children in my care, custody, and control, for bodily injury, death or loss of personal property and expenses as a result of those inherent risks and dangers identified herein and those inherent risks and dangers not specifically identified, and as a result of my negligence in participating in this activity.

In the event that I file a lawsuit against WMG in connection with this activity conducted on NFS lands, I agree to do so solely in the state of Utah, and I further agree that the substantive law of that state shall apply in that action without regard to the conflict of laws rules of that state. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portions shall remain in effect.

I have carefully read, clearly understood and accepted the terms and conditions stated herein and acknowledge that this agreement shall be effective and binding upon myself, my heirs, assigns, personal representative and estate and for all members of my family, including minor children.
Name *

First Name Last Name
Signature *

Clear
Today's Date (please use format DD-MM-YYYY) *

Month Day Year
Date
Signature of Parent of Guardian, if participant is under 18 years of age
MINOR'S/MINORS’ NAMES
PARENT'S/GUARDIAN'S NAME
Signature Parent/Guardian

Clear
Today's date (use format MM-DD-YYYY)

Month Day Year
Date
Should be Empty:

Wasatch Mountain Guides LLC

Dear Adventurer,

Personal Information

An Emergency Contact

Physical Questionnaire

By submitting this form I agree that the above information is true and correct.

Wasatch Mountain Guides

I have read and understood the WMG Terms and Conditions above

Please review, then continue to Page 2

WASATCH MOUNTAIN GUIDES LLC