PLEASE READ THE FOLLOWING BEFORE SIGNING:
WHEREAS, THE UNDERSIGNED (“the APPLICANT”) wishes to be accepted for participation in a Ropes Course/Challenge Course Training Workshop or other Adventure-based program to be organized and conducted by Higher Ground Conference and Retreat Center of West Harrison, Indiana: and in consideration of Higher Ground’s action in allowing the applicant to participate in such a program. The applicant also allows use of their photo and/or comments for print materials: The undersigned acknowledges that during the said workshop or program that the Applicant has requested to participate in, that certain risks and dangers exist. These include, but are not limited to, the hazards of traveling terrain, depending on other people and being at various heights (ground to over 40’), accident or illness in remote places without medical facilities, the forces of nature and travel by air, train, boat, automobile or other conveyance.
The undersigned further recognizes that these risks may also include loss or damage to personal property, physical or psychological damage and/or injury not excluding fatality due to accidents which may occur, including accidents resulting from this course experience or other type of outdoor activities. I further understand that participation in the activities I am requesting to participate in, I will be exposed to the effects of natural elements, including temperature extremes and inclement weather. I certify that I am completely healthy (both physically and emotionally) and capable of participating in this workshop or program. I have listed on the Health Statement Form any medical condition that Higher Ground should be aware of, which may hinder my participation in the Workshop. However, I understand that it is solely my responsibility to determine whether there is any medical reason that I should not participate in the workshop, and I do not rely on Higher Ground for any assessment of my health or ability to participate in these activities.
In consideration of, and as part payment for the right to participate in such a program and the services arranged for me by Higher Ground, its Shareholders, Directors, Officers, Employees, Agents, and/or Associates (hereafter referred to collectively as “Higher Ground”), I have and do hereby assume all the above risks and any other ordinary risk incidental to the nature of the trip/training, which are not specifically foreseeable, and, for myself, my representative, assigns, heirs, and next of kin, will release and HOLD HARMLESS Higher Ground from any and all liability, actions, causes of action, debts, claims and demands of every kind and nature whatsoever, whether for bodily injury, property damage or loss or otherwise, whether caused by negligence of Higher Ground or otherwise, which I now have or which may arise from or in connection with my program or participation in any other activities arranged for me by Higher Ground, its Shareholders, Directors, Officers, Employees, Agents and/or Associates, and their heirs, executors and administrators, successors and assigns and for all members of my family, including any minors accompanying me.
In short, I cannot sue Higher Ground and if I do I cannot collect any money. In addition, I will be liable for Attorney and Court fees associated with any litigation against Higher Ground. I also state that I am not under, and will not be under the influence of any chemical substance including alcohol. I fully understand that my physical activity involves risk of injury. I also understand that my participation in this Higher Ground activity is completely and entirely VOLUNTARY. I enter this workshop and take full responsibility for my decision to participate or not to participate and agree to follow all safety instructions. I hereby give permission to the medical personnel selected by Higher Ground to order injections and/or anesthesia and/or surgery for me. Such authorization for emergency treatment shall also include, but not be limited to: charges incurred for the providing of aid and arranging evacuation if Higher Ground or its agents, determined that such evacuation is necessary or desirable.
I further agree to assume responsibility for the costs of any specialized means of evacuation and of any medical care and acknowledge that these costs are the financial responsibility of the undersigned. I also understand and agree to abide by any restrictions placed on my activities.