Adventure Planner

Name*

First NameLast Name

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Willing to Travel?*

InternationalNationalRegionalState

Preferred Destination? *

What adventure are you interested in? (click all that apply)*

What is your budget for this adventure? *

I'm interested in booking:

Solo Adventure ($250 - covers you plus 1 kid or spouse)Family Adventure ($500 - covers up to 5 family members)Small Group Adventure ($750 - cover up to 10 people)Large Group Adventure ($1,000 - covers up to 20 people)X-Large Group Adventure ($2,000 - covers up to 50 people)I am a disabled Veteran or First Responder with financial hardship.

Are you military or first responder? (Must provide proof)*

Physical Limitations?*

No limitationsSome limitationsWheelchair bound

How much do you weigh?*

EXPERIENCE (Please describe any relevant experiences you have associated to this application)*

Who will be joining you?*

Group information:*

Name of organization?

RELEASE OF LIABILITY, VOLUNTARY ASSUMPTION OF THE RISK, AND WAIVER OF CLAIM AGREEMENT

1. I recognize that participation in outdoor adventures are hazardous activities that are inherently dangerous. 2. I understand that this event contains natural and manmade risks that could lead to death or dismemberment. 3. I have voluntarily entered the adventure despite all known and unknown risks of serious personal injury and/or death presented by preparing for and participating in this event. 4. I will not participate unless I am physically, medically, and mentally able to do so. 5. I know my own capabilities and limitations regarding participation in this event. 6. I will not consume any alcohol or illegal drugs prior to or during this event, will behave in a polite and respectful manner (no vulgarity, racism, gender biases, arguing, stealing, fighting, cheating, etc.). 7. I am at least 18 years of age or my parent or guardian has consented to my participation in this event. 8. I grant permission to Adventure America LLC, 10 CAN, Inc., its affiliates, sponsors, and assigns to use any photographs, motion pictures, recordings, or any other record of this event for any purpose including but not limited to promoting advertising, and marketing purposes. Any and all photographs, motion pictures, recordings, or other records of the event are the sole property of 10 CAN, Inc. 9. Now, therefore, in consideration of being permitted to participate in the scheduled event, I expressly and freely agree as follows: 10. To assume all risk of serious personal injury or death for me and my family that may arise from participating in or preparing for this event. 11. To waive any and all claims that I may have in the future against Adventure America LLC, 10 CAN, Inc., their officers, licensors, agents, employees, volunteers, directors, shareholders, affiliated entities, subsidiaries, all insurers, and all sponsors, for any and all loss, damage, injury or expense that I may suffer, or that my next of kin may suffer, as a result of participating in this event, due to any cause whatsoever, including but not limited to negligence on the part of Adventure America LLC, 10 CAN, Inc., their officers, licensors, agents, employees, volunteers, directors, shareholders, affiliated entities, subsidiaries, all insurers, and all sponsors. 12. To release from liability and hold harmless Adventure America LLC, 10 CAN, Inc., their officers, licensors, agents, employees, volunteers, directors, shareholders, affiliated entities, subsidiaries, all insurers, and all sponsors for any and all loss, damage, injury, or expense that I may suffer, or that my next of kin may suffer, as a result of participating in this event, due to any cause whatsoever, including but not limited to negligence on the part of Adventure America LLC, 10 CAN, Inc., their officers, licensors, agents, employees, volunteers, directors, shareholders, affiliated entities, subsidiaries, all insurers, and all sponsors. 13. I agree that any claim which I may at any time bring for any reason associated with this event shall be submitted to the State or Federal Courts in the State of Florida and no other jurisdiction. Any claim brought shall be governed by the laws of the state in which the claim arose.

Signature*

A deposit is required prior to our team planning your adventure. Scholarships available for military and first responder personnel.

Proof of Service (please redact SSN)