Girl Scouts Heart of Michigan (GSHOM)

Adventure Program Consent Form

This form needs to be completed for each individual participating in the Adventure Program.

Please initial each section after reading:

• I understand that the adventure program activities include without limitation the following: Swimming, boating, air rifle, archery, hatchet throwing, rock climbing, sling shot, horseback riding ("Equestrian Program"), hiking, and all camping related activities.
• I understand that my and/or my child's participation in the adventure program is based on the "Challenge by Choice" philosophy. I recognize that this program is designed to use experiential and engaging teaching techniques, but that my and/or my child's participation is purely voluntary. At all times the participant will assess and choose their level of participation in any activity. I have read the Full Value Contract included in this document, and and/or my child agree to follow the guidelines as presented.
• I understand that the GSHOM follows a ridged safety program, but that no adventure activity is 100% risk-free. The failure to follow the safety guidelines set forth by GSHOM adventure staff may result in injury or death.
• I understand that GSHOM is not responsible for total or partial acts, occurrences, or nature or weather conditions that could negatively affect the ability to participate in an adventure program. Some examples are: thunder; lightening; rain; wind; water, and irregular terrain and footing.
• I understand that GSHOM will provide the appropriate safety equipment, including helmets, harnesses, eye protection, arm guards, and other relevant safety gear related to the activities to participants in order to avoid injuries or even death. I understand that the safety equipment must be used when participating in the activity. It is also understood that GSHOM staff will do their best to ensure a proper and secure fit of all safety equipment, but not every participant's equipment will fit perfectly.
• With regard to the Equestrian Program:
  • I understand that the GSHOM follows a ridged safety program, but that no horse is 100% risk-free. If a rider were to fall from a horse, the general distance to the ground will be 3.5 to 5.5 feet, and the impact may cause injury to the rider.
  • I understand that a horse may be easily and unpredictably frightened or provoked; and may divert from its training and act according to its natural instincts, which may include, but is not limited to: stopping short; changing direction or speed at will; shifting its weight; bucking; rearing; kicking; biting, or running from danger.
  • I understand that once a rider mounts a horse and takes up the reigns, they are in primary control of the horse, and that their safety largely depends on his/her ability to follow simple instructions and remain balanced while on the moving animal.
  • I understand that GSHOM is not responsible for total or partial acts, occurrences, or nature or weather conditions that could scare the horse. Some examples are: thunder; lightening; rain; wind; water; other animals, and irregular terrain and footing.
  • I understand that there is the possibility that the saddle girths (the fasteners that go around the horse's belly) may loosen during a ride. If notice this, I agree to alert the nearest GSHOM staff member or volunteer.
  • I understand that GSHOM will provide protective headgear to each rider in the interest of preventing head injuries or even death. I understand that the headgear needs to be worn while mounting, riding, dismounting, and any other activities that require the participant to be around/near the horses. It is also understood that GSHOM staff will do their best to ensure a proper and secure fit of the headgear for all riders, but not every rider's headgear will fit perfectly.
• I understand that the employees of GSHOM camps have received extensive training and will work to protect the physical and emotional safety of each participant.
• I understand that all Adventure Program activities entail a level of risk. I elect my and/or my child's participation in this program in spite of these risks.
• Therefore, I voluntarily assume all risks involved in my and/or my child's participation, and do hereby (for me and my child) release GSHOM, its camps, and its members, volunteers, representatives, trustees, officers, employees, independent contractors and agents from any and all liability, damages, claims, costs and expenses arising out ofor relating to any bodily or psychological injury, loss of life, or loss of personal property that may occur as a result of participating in Adventure Programs.
• I have read, understand, and accept the terms and conditions stated herein, and acknowledge that this agreement shall be effective and binding upon the participants during the entire period of their participation in the Adventure Program.

The Full Value Contract

The Full Value Contract is a set of agreements designed to help groups create a positive, creative and safe learning environment. While some groups may choose to expand upon this contract, the basic tenets of a Full Value Contract that all participants are expected to uphold include the following:

• Be Safe- Create a level of physical and emotional safety so that people are able to relax and feel comfortable. An agreement that participants must adhere to certain physical and psychological safety guidelines must be discussed and agreed upon by the group.
• Be Committed- Be present mentally, physically and emotionally. Group members will work together to achieve individual and group goals that have been discussed and established Group members should work to minimize distractions.
• Be Respectful- Share your thoughts and opinions openly and honestly. The group should also agree to give and receive honest feedback, which requires the group to care about both the individual and the community in order to communicate productively. This includes being positive, not putting yourself or others down, and practice active listening.
• Challenge By Choice- Each participant may select the level to which they feel comfortable participating in the program.
• Have Fun- Fun is a positive consequence of striking a balance between focusing on the instructions and challenge at hand, and teracting is social situations when appropriate.