Allergies

If you have a known allergy, please list below. Please note that we may not be able to provide prescription or OTC medications for allergic reactions. Medication for an existing condition is the responsibility of the participant. *Emergency medical care is always provided by our guides who are all certified in CPR or Wilderness First Aid.*

Acceptance Affirmation

I affirm that I am (the applicant is) in good general health and not under a doctor's care for any condition which will endanger my {the applicant's) health or the health of others on the trip. I also accept the stated limitations and exclusions as set forth through the camper insurance coverage carried by Voice of the Wilderness and assume full responsibility for payment of any medical costs not covered by or exceeding the policy limitations {Camper Insurance policies are available for review upon request for those without personal coverage.)

PARTICIPANT RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT

In consideration of being allowed to participate in any way in the program, related events and activities (hereafter called the Program), I the undersigned, acknowledge, appreciate, and agree that:
1. The risk of injury from the activities involved in this program is significant during all phases of the activity, including the potential for permanent paralysis, disability and death. These risks include but are not limited to: Equipment failure and/or malfunction of my own or other's equipment; my own negligence and/or the negligence of others; Attack or encounter with insects, reptiles and/or animals; Fatigue, chill and/or dizziness which may diminish my/our reaction time and increase the risk of accident; Outdoor activities include but are not limited to risks of exposure to elements, excessive heat, hypothermia, impact of the body upon the water, injection of water into my body orifices, exposure to animals with the risk of them kicking, biting, shying away, running off or otherwise moving in an unanticipated manner causing injury and/or death. I agree to wear any necessary safety equipment provided to me and recognize that failure to do so increases the potential for severe injury or death and absolves the RELEASEES from any liability whatsoever.
2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation in the Program.
3. I willingly agree to comply with terms and conditions for participation. If I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately.
4. I recognize that it may be necessary for VOW, INC. to refuse or terminate my participation if I am judged to be incapable of meeting the rigors or requirements of the Program. I accept VOW, INC.’s right to take such actions for the safety of myself and/or other participants. I will not engage in any activity beyond my capabilities and will not cause any third party to be endangered by any of my actions during the program.
I warrant and represent that I am in good health and have no physical or mental limitations or problems that would affect my safe participation or the safety of others in the program and have not been advised otherwise by a qualified medical person.
5. By participating in or attending any activity in connection with this program, whether on or off the premises, I consent to the use of any photographs, pictures, film or videotape taken of me or provided by me for publicity, promotion, television, websites or any other use, and expressly waive any right of privacy, compensation, copyright or other ownership right connected to same.
6. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS VOW, INC., its officers, directors, officials, agents and/or employees, other participants, sponsors, advertisers, permit grantors, independent contractors, sub-contractors and, if applicable, owners and lessors of premises used to conduct the Program (RELEASEES), from any and all claims, demands, losses, and liability arising out of or related to any INJURY, DISABILITY OR DEATH I may suffer, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

BY ACCEPTING AND SUBMITTING THE VOW, INC. REGISTRATION FORM, I (PARTICIPANT) HEREBY AGREE TO THE CONTENTS OF HEREIN.

FOR PARENTS/GUARDIANS OF PARTICIPANT OF MINOR AGE (UNDER AGE 18 AT TIME OF REGISTRATION) This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all VOW, INC., and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless VOW, INC. from any and all liability incidents due to my minor child's involvement or participation in these Programs as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by law.

BY ACCEPTING AND SUBMITTING THE VOW, INC. REGISTRATION FORM, I (PARENT / GUARDIAN OF MINOR PARTICIPANT) HEREBY AGREE TO THE CONTENTS OF HEREIN.

You must READ, COMPLETE, and SIGN this form in order to participate.

Your Responsibilities:
Medical Considerations: If you have any medical or psychological conditions, it is very important you let us know well before departure so that we can make extra arrangements if necessary. Trip leaders have the right to disqualify anyone at any time during the trip if they feel the trip member is mentally or physically incapable to continue and/or if a trip member's continued participation jeopardizes the groups or his/her own safety. Under these circumstances refunds are not given. Voice of Wilderness is not a medical facility and therefore has no responsibility regarding medical advice, medications, or inoculations that you or your doctor deem necessary for your safe participation; to include personal prescription medications (ex. EpiPen). Hospital facilities for serious problems are often unavailable, and evacuation can be prolonged, difficult and expensive. Voice of Wilderness assumes no liability regarding provision of medical care. By signing the Medical Form, you agree to pay for emergency evacuation and emergency medical care. Voice of Wilderness reserves the right to decline to accept or retain any person as a participant should such person's behavior, health or mental condition impede the operation of the trip.

It is highly recommended that you consult with your personal physician prior to participation. Many trips are conducted in outdoor, remote locations at altitudes of 8000-14,000ft with the possibility of weather extremes. Strenuous, continuous physical activity, over varied terrain, including carrying a 50-75lb backpack may be required.

Important Notes:
1. If you will be carrying prescription medication you are advised to consult with your physician regarding secondary dosage in the event of possible loss or water contamination
2. If you have ever had a systemic reaction to an insect sting, we recommend you consult your physician about carrying a personal Ana-kit or EpiPen.

COVID-19 Liability Waiver:
I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing.

I further acknowledge that Voice of Wilderness has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19.

I further acknowledge that Voice of Wilderness cannot guarantee that I will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, staff, and other participants and their families.

I voluntarily seek services provided by Voice of Wilderness and acknowledge that I may be increasing my risk to exposure to the Coronavirus/COVID-19. I acknowledge that I must comply with all set procedures to reduce the spread while participating in my trip.

I attest that:
• I am not experiencing any symptom of illness such as cough, shortness of breath or
difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache,
sore throat, or new loss of taste or smell.
• I have not traveled internationally within the last 14 days.
• I have not traveled to a highly impacted area within the United States of America in the
last 14 days.
• I do not believe I have been exposed to someone with a suspected and/or confirmed
case of the Coronavirus/COVID-19.
• I have not been diagnosed with Coronavirus/Covid-19 and not yet cleared as non-
contagious by state or local public health authorities.
• I am following all CDC recommended guidelines as much as possible and limiting my
exposure to the Coronavirus/COVID-19.

I hereby release and agree to hold Voice of Wilderness harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of the organization, or that may otherwise arise in any way in connection with any services received from Voice of Wilderness. I understand that this release discharges Voice of Wilderness from any liability or claim that I, my heirs, or any personal representatives may have against the organization with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from Voice of Wilderness. This liability waiver and release extends to the organization together with all owners, staff, and participants.

Swimming Assessment:
Many Voice of Wilderness trips involve activities in a water environment, which require basic swimming skills. We ask that participants assess their own comfort level in and around the water. We recommend that you do not register for a course involving water activities if you are a non-swimmer.

DRUG, ALCOHOL, and TOBACCO POLICY:
Voice of Wilderness has a Zero Drug and Alcohol policy, to include misuse of prescription medications. Additionally, any medication that may cause impairment may disqualify a participant from an activity. Voice of Wilderness also does not allow tobacco products/use during its programs or on premises.

MEDIA RELEASE

I understand that during the course of this event, pictures and video may be taken. I hereby release Voice of Wilderness to use such print and digital media at their discretion for advertising and promoting Voice of Wilderness adventures and merchandise.

ACKNOWLEDGEMENT

I have reviewed this entire medical form and have verified that all information is given fully and truthfully. To the best of my knowledge, I am capable to safely participate in a VOW trip. I also accept the stated limitations and exclusions as set forth through the Camper Insurance Coverage carried by VOW and assume full responsibility for payment of any medical costs not covered by, or exceeding the policy limitations in the event of an emergency.
Permission is given for emergency medical care.