Desert Mountain Medicine, Inc.:
Acknowledgment and Assumption of Risks & Release and Indemnity Agreement Adult Participants (those 18 yrs. of age and older)
INTRODUCTION
Please read this entire Document (hereafter 'Document') carefully before signing. All adult participants must sign this Document. In consideration of the services of Desert Mountain Medicine, Inc., and its owners, officers, directors, employees, representatives, agents, volunteers, independent contractors, and all other persons or entities associated with it (collectively referred to in this Document as 'DMM'), I acknowledge and agree as follows: Desert Mountain Medicine contracts with individuals or organizations that are independent contractors (not their employees or agents) to provide some of the services, and to conduct some of the activities participants may engage in. Although Desert Mountain Medicine has made efforts to locate responsible contractors, it does not supervise or control these contractors and is not responsible for their conduct. I acknowledge that I may independently investigate and assess these other individuals or organizations, if I desire.
ACKNOWLEDGMENT & ASSUMPTION OF RISKS
DMM instructional, educational and/or adventure activities taking place in the United States or other countries (which may be scheduled or unscheduled, supervised or unsupervised. conducted by DMM staff or contractors and/or occur during free time) include but may not be limited to: wilderness medical training, including but not limited to courses in wilderness emergency medical technician, wilderness first responder, wilderness first aid, wilderness swiftwater technician, avalanche rescue and evacuation training, and other activities such as hiking, backpacking, camping, backcountry skiing, rafting, kayaking, mountaineering, rock and ice climbing, or travel to and from activities (collectively referred to in this Document as 'activities'). These activities include inherent and other risks, hazards and dangers (collectively referred to in this Document as ‘risks’) that can cause or lead to injury, damage, death or other loss to me or others. The following includes some, but not all of those risks: Risks involved in physical activity. DMM activities include a variety of both indoor and outdoor physical activities. These activities include running, sustained climbing or hiking, and repetitive lifting or carrying of objects of people. Risks present in an outdoor or wilderness environment. These risks include travel in high altitude, mountainous or wilderness terrain, both on and off trail. Travel can be subject to storms, strong winds, avalanches, currents, waves, whitewater, lightning, rapidly moving rivers or other water bodies, difficult stream crossings, snow or ice, extremely hot, humid or cold weather or water, steep terrain, falling rock, falling or fallen timber, stinging or disease carrying animals or insects, poisonous plants, wild animals and other natural or man-made hazards and dangers. Hazards may not be marked or visible and weather is unpredictable year-round. Risks in decision making, including, without limitation, the risk that a DMM staff member, volunteer, representative, co-participant or contractor may misjudge a participant’s capabilities, health or fitness level, or misjudge some aspect of instruction, medical treatment, weather, terrain, water level, or route location. Personal health and participation risks. The risk that participant’s mental, physical or emotional condition (disclosed or undisclosed, known or unknown) combined with participation in these activities could result in injury, damage, death or other loss. Although DMM personnel may review participant's submitted medical information, DMM cannot anticipate or eliminate risks or complications posed by participant’s mental, physical or emotional condition. The risk that equipment used in an activity may be misused, or may break, fail or malfunction. Risks associated with geographic location. DMM activities may take place in remote places, several hours or days from any medical facility, causing potential delays or difficulties with communication, transportation, evacuation and medical care. Risks connected with cooking and camping chores. Risks include gas explosion, scalding or other burns associated with cooking over a gas stove or open fire, and water contamination in natural water sources. All water may be contaminated and should be disinfected, filtered or boiled before use. Risks associated with DMM or other parties’ premises, including boulders, ruts, slippery walkways, ponds or other water sources, uneven ground or other conditions. Risks associated with transportation. Travel can be on foot or by vehicle, boat or other means and can be over rough and unpredictable terrain or via oceans or rivers, with wind, rain, or other adverse weather conditions. Risks regarding conduct, including the potential that the participant, or other participants or third parties (e.g. general public, rescue squad, medical facility) may act carelessly or recklessly. Risks associated with free time. Participants will have unsupervised time during, before or after the start of a DMM program. This may include periods of free time, or periods of time alone while engaged in backcountry travel. During both supervised and unsupervised activities, all participants share in the responsibility for their own safety and the safety of the group. Other risks that are generally associated with instructional, educational and/or adventure activities. These and other risks may result in participants falling, being struck, colliding with objects or people, experiencing vehicle or boat collision or capsize, drowning, reacting to high altitude, weather conditions or increased exertion, suffering gastro-intestinal complications or allergic reactions, becoming lost or disoriented, or experiencing other problems. These and other circumstances may cause hyperthermia (heat related illness), hypothermia, high altitude sickness, frostbite, dehydration, heat exhaustion, sunburn or other © Catherine Hansen-Stamp, final draft 11/20/06; attorney/client privilege protected communication Page 2 of 2 Please read both pages carefully and sign on page 2! burns, heart or lung complications, broken bones, concussions, paralysis, mental or emotional trauma, or other injury, damage, death or loss. I agree: • To accurately complete all required forms, abide by the terms of those documents, and obey all DMM rules, regulations and policies; • If I have any mental, physical or emotional conditions or limitations that might affect my ability to participate I agree to disclose those to DMM, and represent that I am fully capable of participating without causing harm to myself or others; • DMM representatives are, and have been available, should I have further questions about these activities and the associated risks, and cannot assure my safety or eliminate any of these risks. I am voluntarily participating with knowledge of the risks. Therefore, I assume and accept full responsibility for the inherent and other risks (both known and unknown) of these activities, and for any injury, damage, death or other loss suffered by me, resulting from those risks and/or resulting from my negligence or other misconduct. RELEASE AND INDEMNITY AGREEMENT Please read carefully. This Release and Indemnity agreement contains a surrender of certain legal rights. Certain federal land agencies (including the National Park Service and some regions of the U.S. Forest Service) restrict service providers from seeking releases of liability for negligence, for injuries or other losses occurring while operating under permit or concession on those federal lands. Therefore, except to the extent a court determines these federal restrictions are enforceable against DMM as a matter of law, I agree as follows: (1) to release and agree not to sue DMM, with respect to any and all claims, liabilities, suits or expenses (including attorneys’ fees and costs) (hereafter collectively ‘claim’ or ‘claim/s’) for any injury, damage, death or other loss in any way connected with my enrollment or participation in these activities or use of DMM or other parties’ equipment, facilities or premises. I understand I agree here to waive all claim/s I may have against DMM, and agree that neither I, nor anyone acting on my behalf, will make a claim against DMM, as a result of any injury, damage, death or other loss suffered by me; (2) to defend and indemnify (‘indemnify’ meaning protect by reimbursement or payment) DMM with respect to any and all claim/s brought by or on behalf of me, my spouse or other family member, a co-participant, or any other person for any injury, damage, death or other loss in any way connected with my enrollment or participation in these activities or use of DMM or other parties’ equipment, facilities or premises. This Release and Indemnity Agreement includes claim/s resulting from DMM’s negligence (but not its gross negligence or willful, wanton or criminal misconduct), and includes claim/s for personal injury or wrongful death (including claim/s related to emergency or medical response, assessment or treatment), property damage, breach of contract or any other claim. CONCLUSION I agree that Colorado law (without regard to its conflict of laws rules) governs this Document, any dispute I have with DMM and all other aspects of my relationship with DMM, and that any mediation, suit, or other proceeding must be filed or entered into only in Colorado. I agree to attempt to settle any dispute (that cannot be settled by discussion) through mediation before a mutually acceptable Colorado mediator. DMM reserves the right to remove any participant from the program who staff or leaders believe, in their discretion, presents a safety concern or medical risk, is disruptive, or acts in any manner detrimental to the program. If I am dismissed or depart for any reason, I agree I am responsible for all costs of early departure whether for medical reasons, dismissal, personal emergencies or otherwise. These costs include, but are not limited to medical evacuation and costs, plane, train or taxi fare, accommodations, and costs and compensation for staff accompanying participant. This Document is intended to be interpreted and enforced to the fullest extent allowed by law. If any portion of this Document is deemed unlawful or unenforceable it shall not affect the remaining provisions, and those remaining provisions shall continue in full force and effect. I agree: I have carefully read, understand and voluntarily sign this Document and acknowledge that it shall be effective and binding upon me, my minor children, spouse and other family members, and my heirs, executors, representatives and estate.
WFA