Vision Walk Registration

Vision Walk

P.O. Box 57 • Sandpoint, ID 83864 • (208) 217-5788 • www.ritesofpassagesandpoint.com
To register for the Rites of Passage Vision Walk, please fill out the following questions and sign the waiver.

Event location and packing lists will be emailed to you after registration is received.

Looking forward to being on the land together!
Participant Information
I wish to enroll in the Vision Walk
Participant Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail
example@example.com
Phone Number
Format: (000) 000-0000.
Please tell us your experience navigating the outdoors. Have you spent a day in the wilderness before?
Let your guides know what hopes you have in participating in the Vision Walk? Do you have a clear intention or desired outcome?
Do you have any access or accommodation needs you'd like us to be aware of?
Confidential Health Questionaire: Do you have any hospitalizations, surgeries or health conditions diagnosed? Please list conditions and dates of diagnosis below, including physical and mental/emotional conditions:
Are you currently under the care of a mental health practitioner, psychotherapist or psychiatrist? If so, how long have you been in their care?
Do you have any allergies? If so, what are you allergic to and do you carry an epi-pen?
If you are currently taking medications to treat health conditions, please list them here:
Waiver
PARTICIPANT RELEASE OF LIABILITY, WAIVER OF CLAIMS, EXPRESS
ASSUMPTION OF RISK AND INDEMNITY AGREEMENT

Please read and be certain you understand the implications of signing.
Express Assumption of Risk Associated with Wilderness Rites of Passage.
I, Name of Participant* do hereby affirm and acknowledge that I have been fully informed of the inherent hazards and risks associated with dba RITES OF PASSAGE SANDPOINT, MOTHER ELEMENT, LLC. Inherent hazards and risks of outdoor activities include, but are not limited to:

1. Risk of injury or death from exposure to flora and fauna in the wilderness.
2. Exposure to the elements and temperature extremes which may result in heat
exhaustion, heat stroke, sunburn, hypothermia and dehydration, inclement
weather, thunder and lightning, severe and/or varied wind, temperature and other
weather conditions.

*I understand the description of these risks is not complete and unknown or
unanticipated risks may result in injury or illness.
Release of Liability, Waiver of Claims and Indemnity Agreement
In consideration for being permitted to participate in the above described activity(ies) and related activities I HEREBY AGREE THAT I, MY SPOUSE, MY ASSIGNEES, HEIRS, GUARDIANS AND LEGAL REPRESENTATIVES WILL NOT MAKE A CLAIM AGAINST OR SUE dba RITES OF PASSAGE SANDPOINT, MOTHER ELEMENT, LLC ON ACCOUNT OF ANY AND ALL INJURY, OR LOSS OR DAMAGE TO PERSON OR PROPERTY, RESULTING FROM THE NEGLIGENCE OR OTHER ACTS, HOWSOEVER CAUSED BY dba RITES OF PASSAGE SANDPOINT, MOTHER ELEMENT, LLC.
This release shall by binding to the fullest extent permitted by law. If any provision of this release is found to be unenforceable, the remaining terms shall be enforceable.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK
AGREEMENT, I FULLY UNDERSTAND ITS TERMS.
Signature
Today's Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

My Products

Vision Walk

REFUND POLICY: ROPS does offer refunds up to 30 days before an event. However refunds amount will not be full amount paid, due to bank fees which vary between 3-4% of enrollment cost. No refund is available within 29 days of the event.

$155.00

Vision Walk Sliding Scale

For participants unable to pay full price event low fee is offered. REFUND POLICY: ROPS does offer refunds up to 30 days before an event. However refunds amount will not be full amount paid, due to bank fees which vary between 3-4% of enrollment cost. No refund is available within 29 days of the event.

$78.00

Total

Debit or Credit Card
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Credit Card Number	Security Code
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Vision Walk

Participant Information

Waiver

My Products