Participant Accident Waiver

Accident Waiver & Release of Liability Form

Please fill out the following form in order to participate in our activity.

This form must be completed before the start of the excursion by each participant registered for the excursion.

First name

Last name

Date of Birth

WHEREAS, I, the undersigned, with full and complete understanding of all risks and associated with ACT3 Explorations, do hereby assume full responsibility and all risk, chance and hazard for any and all personal and bodily injuries, and property damage that may result to me from my participation in ACT3 Explorations activities , and I assume all risks inherent to these activities..

Agree

Disagree

I CERTIFY that I am physically fit, have sufficiently prepared or trained for participation in this activity, and have not been advised to not participate by a qualified medical professional. I CERTIFY that there are no health-related reasons or problems which preclude my participation in this activity.

Agree

Disagree

In consideration of being allowed to participate in the registered excursion, I hereby waive, release and forever discharge the event holders, sponsors, and organizers of the activity of ACT3 Explorations, and their officers, directors, employees, agents and volunteers from any and all claims, liabilities, losses, damages, expenses, actions and causes of action of every nature and kind arising out of or relating in any way to the activities offered during registered ACT3 Explorations’ excursion. *

Agree

Disagree

I agree to indemnify, hold harmless, and promise to sue the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in this activity, whether caused by the negligence of release or otherwise. I acknowledge that ACT3 Explorations and their volunteers and representatives are NOT responsible for errors, omissions, acts, or failures to act of any party or entity conducting a specific activity on their behalf. Check if you agree.

I declare that the info I’ve provided is accurate & complete, and certify I am 21 years of age or older and mentally competent.

Full Name

Date Signed

Your Signature

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