Participant Agreement

PARTICIPANT RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT

In consideration of being allowed to participate in any way in an activity with Colorado Backcountry LLC (also doing business as Backcountry Bike Academy), including all related events and transport to and from the activities, I the undersigned, acknowledge, appreciate, and agree that:

1.(Required)

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: a) Cold weather and heat related injuries and illnesses including frostnip; frostbite; heat exhaustion; heat stroke; altitude sickness; hypothermia and, dehydration; b) “acts of nature” which may include rock fall; landslides; avalanches; inclement weather; thunder and lightning; severe and/or varied wind; temperatures; fire; flood; earthquake; and other weather or environmental hazards; c) River crossings; d) Travel to, during and from activities by motorized or mechanized means not limited to automobiles, helicopters, bicycles, snowmobiles, skis, snowshoes e) Risk associated with mountain activities (e.g. skiing; hiking; crossing, climbing or down-climbing of rock, snow and/or ice) not limited to loose, slippery or falling rock; avalanches; cornices; cliffs; treewells; snow covered objects; hazardous snow conditions; falling on or through ice; or immersion in deep snow or water; f) Equipment maintenance, failure and/or operator error; g) Tripping, slipping, falling, my sense of balance, physical coordination, physical abilities and/or limitations; and my ability to follow instructions; h) Attack by or encounter with insects, reptiles, and/or wild or domestic animals; i) Accidents or illnesses occurring in remote places where there are no available medical facilities; j) Fatigue, chill, and/or dizziness, which may diminish reaction time and increase the risk of an accident or injury; and k) The availability and proficiency levels of backcountry rescue and medical treatment.

I acknowledge the description of these risks is not complete and that unknown or unanticipated risks may result in property damages, personal injuries, illness, or death. I agree to wear and use as instructed any necessary safety equipment. I recognize that failure to do so increases the potential for severe injury or death and absolves the RELEASEES from any liability whatsoever.

I Agree(Required)

Date(Required)

Participant Info

Name(Required)

First Last

Phone(Required)

Gender

Female

Male

Non-binary

Participant Date of Birth(Required)

Age(Required)

Please enter a number from 1 to 100.

Date and Activity

Please list the date of your trip and type of activity you will participate in.

Medical Issues/History

So that our staff can a) accommodate your needs, and b) assist you in the event of an emergency, please describe any present medical issues or past medical history.

Skill Level

Please describe your prior experience and skill level doing the activity that you will do with us.

Beginner

Intermediate

Expert

Special Requests

Please let us know if you have any special requests for your upcoming activity, including what you might like to learn, see, do or any accommodations required.

Email(Required)

Emergency Contact Name

First Last

Emergency Contact Phone(Required)

Signature(Required)

Minors

Number of Minors(Required)

Minor 1 Info

Minor 1 Name(Required)

First Last

Minor 1 Phone(Required)

Minor 1 Date of Birth(Required)

Minor 1 Age(Required)

Minor 2 Info

Minor 2 Name(Required)

First Last

Minor 2 Phone(Required)

Minor 2 Date of Birth(Required)

Minor 2 Age(Required)

Minor 3 Info

Minor 3 Name(Required)

First Last

Minor 3 Phone(Required)

Minor 3 Date of Birth(Required)

Minor 3 Age(Required)

Minor 4 Info

Minor 4 Name(Required)

First Last

Minor 4 Phone(Required)

Minor 4 Date of Birth(Required)

Minor 4 Age(Required)

Minor 5 Info

Minor 5 Name(Required)

First Last

Minor 5 Phone(Required)

Minor 5 Date of Birth(Required)

Minor 5 Age(Required)

Minor 6 Info

Minor 6 Name(Required)

First Last

Minor 6 Phone(Required)

Minor 6 Date of Birth(Required)

Minor 6 Age(Required)

Parent Guardian Info

Parent/Guardian's Name(Required)

First Last

Relationship(Required)

Parent/Guardian's Phone(Required)

Parent/Guardian's Date of Birth

Parent/Guardian's Email(Required)

Emergency Contact Name(Required)

First Last

Emergency Contact Phone(Required)

Parent/Guardian Signature(Required)

PARTICIPANT RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT

Participant Info

Minors

Minor 1 Info

Minor 2 Info

Minor 3 Info

Minor 4 Info

Minor 5 Info

Minor 6 Info

Parent Guardian Info

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