LIABILITY RELEASE & PERSONAL INFORMATION FORM
Adirondack All Seasons Guide Service. 165 Elm Street · Lake Placid, NY 12946. (518) 523-1341 (tel) or (860) 713-8205 (cell)
Activity(s): ________________________________________________ Date(s) of trip: __________________
Any outdoor activity can be dangerous and there is an element of risk, which you are accepting by participating in this activity. You alone assume responsibility for your own safety and equipment and must be both physically and mentally prepared and equipped with the appropriate gear. Only you can judge your skills relative to the conditions found in the backcountry (on the trail or water) and any possible risk. You alone decide when, where and how to proceed, or not.
LIABILITY RELEASE and ASSUMPTION OF RISK AGREEMENT
Please read carefully before signing. You must sign and return via mail along with the Confidential Personal Information Form.
Please click here if you wish to download this form in a .DOC format or here to download in a PDF format.
I acknowledge that I have voluntarily chosen to participate in the trip referenced above. In so doing, I acknowledge that I may be subjecting myself to dangers and hazards which could result in illness, injury or death. I also acknowledge that there are inherent risks and dangers that may arise at any time during the trip. In addition, I am specifically familiar with and accept the risks of the dangers and hazards referred to in the trip materials provided to me. I am aware that medical services or facilities might not be available while I am participating in the trip. In consideration of my being permitted to participate in the trip, I agree to assume all risks of illness, injury or death and agree not to sue and to release from liability and indemnify Adirondack All Seasons Guide Service., Adirondack All Seasons Guide Service, their owners, agents, contracted tour operators and employees, and other persons or entities involved with this trip, from all actions, claims or demands for injury, loss or damage, regardless of the cause, resulting from my participation in the trip. I understand that Adirondack All Seasons Guide Service may contract with independent contractors to provide services on this trip, including transportation, travel services and guide services. I understand and acknowledge that Adirondack All Seasons Guide Service has no control over and assumes no responsibility for the actions of any independent contractors involved in providing any services on this trip. I agree that New York state will be the forum for resolution of any dispute related to my participation in this trip. The terms of this agreement shall serve as a release and assumption of risk binding on my heirs, executor, administrator and all members of my family, including any minors accompanying me. I have familiarized myself with all information provided to me about this trip, and I agree to all stated conditions set forth in the Reservation & Payment Information, specifically including any information outlining my responsibilities and obligations as a trip member. I agree to pay for the cost of any evacuation or medical care.
I grant Adirondack All Seasons Guide Service the absolute right to copyright, reuse, publish and republish by any medium, including electronically, any photos of me or in which I may be included, that may be taken while participating in an Adirondack All Seasons Guide Service trip. I also consent to the use of any printed matter in conjunction therewith.
I have carefully read this agreement. I understand that it is a release of liability and a contract between me and Adirondack All Seasons Guide Service, Adirondack All Seasons Guide Service and/or its contracted tour operators or affiliated organizations, and I sign this agreement of my own free will. If any part of this agreement is deemed unenforceable, all other parts shall be given full force and effect.
Participant Signature ______________________________________________________ Date ____________
Parent or Guardian of Participant* __________________________________________ Date ____________
* If I am signing on behalf of a minor, in addition to the above, I also agree to RELEASE, HOLD HARMLESS AND INDEMNIFY the entities named above for any claims of the minor. I agree to be responsible for any medical expenses incurred by the minor.
NOTE: An Adirondack All Seasons Guide Service guide reserves the right to change, re-route, postpone or cancel a trip based on weather and client conditions, for the purpose of ensuring the safety of the client, group and guide.
Adirondack All Seasons Guide Service
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