The Peaks Retreat and Adventure Center Waiver

Informed Consent, Assumption of Risk, and Waiver of Release of Liability for use of THE PEAKS RETREAT AND ADVENTURE CENTER
Participant Name*

First NameLast Name
Participant Birth Date*

MonthDayYear
Date
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
E-mail*
example@example.com
Group/Event Name*
Organization or Group
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Participant or Parent/Guardian Signature

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Participant Age
Today's Date

MonthDayYear
Date
Challenge Course Required Information

This information is required for Users participating in the low ropes course, climbing walls, and/or zip lines.
YesNo
User Weight
In pounds
User Height
Feet and Inches
Should be Empty:

Informed Consent, Assumption of Risk, and Waiver of Release of Liability for use of THE PEAKS RETREAT AND ADVENTURE CENTER