Ropes Course Registration, Health Disclosure, Liability & Photo Release Form
Course Address: 196 Hieronymus Park Drive, Hamilton
Contact us at (406) 363-5410 or mallory.ijames@bearmt.org 
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Registration
A registration form is required for each individual participant and should fill out at least 24 hours in advance of their scheduled facilitation date/time on the course so staff have time to review it prior to the activity.
Group or organization name (please ensure all participants in the group are using the same group name) *
First name of participant *
Last name of participant *
Participant's age *
If the participant is age 6 or younger, a responsible teen or adult must be on site to accompany the participant on the course during the activity. *
Participant's sex *
If participant is under 18 yo, parent/guardian's first & last name
Participant phone number OR parent/guardian's phone number, if participant is under 18 yo *
Emergency contact name (if different from parent/guardian above).
Emergency contact phone number (if different from parent/guardian above)
Heath Disclosure
Does the participant have any limiting physical or health conditions or disabilities that staff should be aware of? If yes, please explain. *
Does the participant have any current injuries, including foot, ankle, knee, shoulder, back, or neck injuries? If yes, please explain. *
Does the participant have any allergies or reactions to medications? If yes, please explain. *
Participant's are responsible for seeking advice from a medical professional prior to participating in the course if they have a condition or injury that may impact their participation. Course staff reserve the right to assess the safety of all participants prior to using the course and to deny access to anyone who's health conditions may cause harm to the participant or others. *
Required
Liability Waiver
PLEASE READ THIS FORM CAREFULLY, and be aware that by signing up and participating in BEAR’s ropes challenge course, you will be waiving and releasing all claims for injuries arising out of these programs that you might sustain.  The terms “I”, “me” and “my” refer to both adult and youth participants, as well as parents or guardians of youth participants.. I understand that participants and parents share the responsibility for participants’ safety, for assessing the risks, and for determining the participant’s suitability for the program in which he/she will participate.  I have accurately completed any required BEAR medical forms and have reviewed all BEAR program information provided to me.  I agree to obey all BEAR rules, regulations, and policies.  I have no mental or physical problems or limitations that might affect my ability to participate that have not been disclosed to BEAR in writing.  I have had the opportunity to ask questions about the program activities and the risks of the program in which I will participate. I understand and acknowledge that the program(s) in which I will participate has risks and it is impossible to anticipate every activity in which I will engage.  I understand I will be participating as part of a group in activities of varying physical degree and these endeavors may involve strenuous exertion.  These activities may be instructional, educational, or adventurous and may include but are not limited to:  ropes and/or challenge courses (traversing ropes suspended off the ground, potentially at great heights, swinging or traveling by a cable and pulleys and other such activities); physical problem solving activities; rock climbing; vehicle travel and travel by public, chartered or other conveyance; rescue scenarios; yoga, jogging, walking and stair climbing.  I understand that I may engage in other activities not listed above.  The planned program may be modified for any number of reasons, including convenience, weather, emergencies or unexpected conditions.  I have the option to decline to participate in any activity.  I acknowledge that participating in BEAR programming involves inherent risks and other risks, hazards, and dangers including some not listed above that can cause or lead to death, injury, illness, property damage, mental or emotional trauma, or disability.   I understand that BEAR cannot assure my safety or eliminate all of these risks.  I agree to assume all of the risks of the activities of my participation in the BEAR program. I also give permission for me or my youth participant to ride with BEAR staff and volunteers to or from program destinations. Drivers must carry auto liability insurance and seatbelts must be worn by passengers at all times.  By signing below I agree to fully absolve BEAR and the driver from liability for any damages, injuries, or losses which might be sustained during transport. *
Required
Photograph Release and Permission
The terms “I”, “me” and “my” also refer to both adult and youth participants, as well as  parents or guardians of youth participants, in BEAR’s ropes challenge course. I do hereby release to BEAR and the Dennis and Phyllis Washington Foundation, their associates, licensees, and legal representatives the right to use my picture, portrait or photograph in all forms and media and in all manners, for any and all purposes, including but not limited to advertising in all forms and display or placement on BEAR’s and/or the Dennis and Phyllis Washington Foundation’s photo albums, bulletin boards, flyers, posters, brochures, newspaper advertisements, and websites.  I waive any right to inspect or approve the finished product, including written copy that may be created in connection therewith.  I also realize that neither myself, my or any other individual related to or not, will receive any financial gains in exchange for these posted and/or printed materials. I further understand and agree that this is a legal and binding document and by affixing my signature hereto acknowledge that I have read and approve the foregoing and waive any rights as articulated above.  
I HAVE CAREFULLY READ, UNDERSTAND, AND VOLUNTARILY SIGN THE PARTICIPANT ACKNOWLEDGEMENT AND ASSUMPTIONS OF RISK AND RELEASE AGREEMENT. *
Required
Type the name of the adult participant or youth's parent/guardian below as your signature. *
If the participant is a youth, this form must be signed by a parent/guardian. *
Required
Would you like to receive information about upcoming BEAR programs and events, for you or other youth in your life? *
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