Wilderness First Aid Registration

Wilderness First Aid Registration

Enter your details to register for the adult Wilderness First Aid course at Willowell on November 7th and 8th, 2026
Full Name

First NameLast Name
Preferred Pronouns
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Emergency Contact Name

First NameLast Name
Emergency Contact Phone
Please enter a valid phone number.Format: (000) 000-0000.
Do you have any allergies?
Are you currently taking any medications?
Do you have any medical conditions we should be aware of?
1. ACKNOWLEDGMENT AND ASSUMPTION OF INHERENT RISKSI hereby acknowledge and understand that participating in the Wilderness First Aid (WFA) course offered by the Willowell Foundation involves inherent risks, dangers, and hazards. I recognize that the course includes physical activity, scenario-based medical practices, and outdoor field exercises that may take place in remote, rugged, wooded, or uneven natural terrain.I understand that the inherent risks include, but are not limited to:

Physical injury, strains, sprains, fractures, or concussions resulting from slips, trips, falls, or carrying simulated patients.

Exposure to unpredictable outdoor elements and weather conditions, including extreme heat, cold, rain, snow, lightning, and solar radiation.

Injuries sustained during hands-on practice, including CPR compressions, splinting, patient movement, and simulated medical interventions performed by instructors or fellow participants.

I voluntarily and freely assume all risks, both known and unknown, associated with my participation in this course, even if arising from the negligence of the Releasees (defined below).

2. RELEASE AND WAIVER OF LIABILITY

In consideration for being permitted to enroll and participate in the Wilderness First Aid course, I, on behalf of myself, my heirs, executors, administrators, personal representatives, and assigns, hereby irrevocably release, discharge, and hold harmless the Willowell Foundation, its directors, officers, employees, agents, instructors, volunteers, land owners, and sponsors (collectively referred to as the "Releasees") from any and all claims, demands, actions, causes of action, suits, damages, liabilities, or costs (including attorney's fees) arising out of or related to any bodily injury, personal injury, illness, death, or property damage that I may sustain while participating in, traveling to, or traveling from the course.

This release expressly includes any claims based upon the ordinary negligence of the Releasees, whether caused by their action, inaction, or the condition of the facilities, equipment, or terrain used during the course.3.

COVENANT NOT TO SUE

I promise and agree that I will not initiate, bring, or participate in any lawsuit, legal proceeding, or administrative claim against the Releasees for any matter released or waived under this agreement.

4. MEDICAL AUTHORIZATION AND FINANCIAL RESPONSIBILITY

I certify that I am physically fit and mentally capable of participating in this course, and I have no medical conditions that would endanger myself or others. In the event of an emergency, illness, or injury during the course, authorization is hereby granted to Willowell Foundation representatives to secure or administer first aid, emergency medical treatment, or transport. I acknowledge that I am solely responsible for all costs and financial obligations associated with such medical care, ambulance transportation, or evacuation, and I maintain adequate health insurance to cover these potential expenses.

ACKNOWLEDGMENT OF UNDERSTANDING:BY SIGNING BELOW, I CERTIFY THAT I HAVE READ THIS ENTIRE DOCUMENT, FULLY UNDERSTAND ITS TERMS, AND UNDERSTAND THAT I AM GIVING UP SUBSTANTIAL LEGAL RIGHTS (INCLUDING THE RIGHT TO SUE). I SIGN IT FREELY, VOLUNTARILY, AND WITHOUT ANY INDUCEMENT.
Legal Guardian (if under 18) or self Signature

Guardian to sign here
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
PHOTO WAIVER (Optional)

By signing your name/date below, You, the student’s parent/guardian or yourself if over age 18, authorize the Willowell Foundation (“Willowell”), to publish the photographs or video taken of the student (first names used only, if any), for use in printed publications, e-newsletters, videos, and on authorized websites (Willowell.org and the AmeriCorps website, Willowell Facebook and Instagram). I acknowledge that since this participation in media produced by Willowell is voluntary, we will receive no financial compensation. I further agree that the student’s participation in any media produced by Willowell carries no rights of ownership whatsoever to me or the student and I do hereby release Willowell and its officers, directors, members, employees/contractors, and associated personnel from any and all manner of liability for any and all manner of claims by me, the student or any third party in connection with their participation.
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Please no photos of me
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Wilderness First Aid

Registration Fee

Adult Wilderness First Aid registration fee

$240.00

CPR (additional two hours)

$50.00 Quantity
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Wilderness First Aid Registration

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Wilderness First Aid*

Wilderness First Aid