Endgame Adventure Registration form

Participant Name*

PrefixFirst NameLast Name

YESNO

If Yes please type parent name.

PrefixFirst NameLast Name

I have a valid passport with an expiration date that allows me to enter Costa Rica and Mexico and reenter the United States of America.Other

Birth Date*

MonthDayYear

Expiration Date on Passport

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Cell Number*

Area CodePhone Number

E-mail*

Name of Emergency Contact

First NameLast Name

Emergency Contact

Area CodePhone Number

I understand

YESNO

If you chose yes please identify any condition that would prevent participation in one or more adventure activities.

YESNO

If you chose yes please list any medication that you are allergic to. An example would be penicillin.

YESNO

If you chose yes please list any food allergies.

Height*

Weight (in pounds)*

General Level of fitness*

	1	2	3	4	5

1 is Couch Potato, 5 is Ready for Crossfit Games

YesNo

I understand that any deposit or final payment is non-refundable

I hereby warrant that I have read this Participant Waiver and Release of Liability in its entirety and fully understand its contents. I am aware that this Participant Release and Waiver Form releases Endgame Adventures LLC from liability and contains an acknowledgement of my voluntary and knowing assumption of the risk of injury or illness. I acknowledge and agree that participation in any Adventure Trip subjects me to possibility of physical illness or injury (minimal, serious, catastrophic and/or death). I have signed this document voluntarily and of my own free will. In the event Participant is a minor, Participant’s Guardian hereby agrees in his or her own behalf and on behalf of the Minor Participant.

Print Your Name*

PrefixFirst NameLast Name

If participant is a minor parent must print name and sign below.

PrefixFirst NameLast Name

I hereby warrant that I have read this Participant Waiver and Release of Liability in its entirety and fully understand its contents. I am aware that this Participant Release and Waiver Form releases Endgame Adventures LLC from liability and contains an acknowledgement of my voluntary and knowing assumption of the risk of injury or illness. I acknowledge and agree that participation in any Adventure Trip subjects me to possibility of physical illness or injury (minimal, serious, catastrophic and/or death). I have signed this document voluntarily and of my own free will. In the event Participant is a minor, Participant’s Guardian hereby agrees in his or her own behalf and on behalf of the Minor Participant.