FULL RELEASE OF LIABILITY AND INDEMNIFICATION AGREEMENT
Personal & Contact Information
Name
*
First Name
Last Name
Age
*
Example: 23
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Emergency Contact 1
First Name
Last Name
Phone Number
Please enter a valid phone number.
Emergency Contact 2
First Name
Last Name
Phone Number
Please enter a valid phone number.
Medical Information
If there is any health conditions, please explain
Astma, diabetes, allergies, medications
Is there any activity restrictions?
Yes
No
If yes, Please explain
Release
I, undersigned, agree with the following statements
*
In consideration of my participation in the ESCAPE 2024 on May 31 - June 2, 2024 , and in order to induce NEW MEXICO EMERGENCY SERVICES COUNCIL (NMESC) to accept my application to participate in the EVENT, I HEREBY FULLY RELEASE and AGREE TO INDEMNIFY and HOLD HARMLESS NMESC, New Mexico Tech, and their members, officers, directors, agents, staff, employees, representatives, volunteers, owners of property on which EVENT occurs, and/or EVENT organizers (ALL PARTIES) of and from ANY AND ALL LIABILITY FOR INJURIES, DEATH or DAMAGES, to persons, and property OF ANY NATURE WHATSOEVER that may arise from, or in connection with, my participation in any aspect of the EVENT, accepting any and all risks involved and waiving all rights of any kind that might otherwise exist. The definition of EVENT shall include all related activities which include, but are not limited to, observing or participating in any activity that may take place before, during or after the EVENT such as, by way of example, but not limitation, horseback riding, driving or riding on any motorized vehicle (including any vehicle designed for off road), camping (including risks associated with camp or cooking fires). This instrument in its entirety shall not only cover the officially sponsored activities of the EVENT but shall protect ALL PARTIES with respect to all activities surrounding the EVENT. I represent that my physical condition is adequate to participate safely in all activities of the EVENT and that no physician or other qualified health care provider has advised me against participating in any such activities. I acknowledge that the EVENT may take place at high altitude in remote and rugged terrain in bad weather, and that any trail party can become lost for a period of time in adverse conditions. I further covenant that I will not sue any one among ALL PARTIES for any injury, loss or damages that may result or in any way be connected to my having participated in the EVENT. I will defend, indemnify and hold harmless ALL PARTIES against all actions, claims, demands and liabilities (including court costs and attorney fees) related to any injury, death, damages, or property damage resulting from or arising out of my participation in an EVENT. I agree this RELEASE AND INDEMNITY AGREEMENT shall be governed by, and construed under, the laws of New Mexico, without regard to conflicts of law principles and without regard to the place of any actual accident or injury. This instrument shall be binding upon my heirs, personal representatives, and assigns. I give consent to having photographs or video taken at this EVENT that may be used in NMESC publications or other NMESC communications. I agree to follow all state and federal guidelines and mandates related to COVID or other infectious disease. I agree to hold ALL PARTIES harmless should I get COVID after an EVENT. I ACKNOWLEDGE AND REPRESENT THAT I HAVE READ THIS INSTRUMENT IN ITS ENTIRETY AND I AM AT LEAST 18 YEARS OF AGE.
Date
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-
Month
-
Day
Year
Date
Signature
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Submit
Submit
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