2018 Adventure Group Registration
Health Statement, Indemnity, Release & Assumption of Risk
"Adventure is not in the guidebooks, and beauty is not on the maps."
Are you signing up a Participant, or are you a Chaperone Participant?
2018 Beth El Challenge Course
2018 Blessed Sac 6th Ropes
2018 Blessed Sac 7th Ropes II
2018 Blessed Sac Raft 8th
2018 BS Troop 61 Cave
2018 BS Troop 8 Leadership O/N
2018 Bullis 12th Challenge Course
2018 Bullis 6th Challenge Course
2018 Bullis 7th Splits/Teambuilding
2018 Bullis 8th Splits/Island
2018 Bullis 9th O/N
2018 Christ Episcopal 5th & 6th Ropes
2018 DSRC Pool Kayaking
2018 Field 9th Challenge Course
2018 Flint Hill 10th Challenge Course
2018 Flint Hill 11th Race
2018 Flint Hill 12th Raft
2018 Flint Hill 9th Splits
2018 GS Troop 6535 Adventure Island
2018 GU Pre-Orientation Sampler
2018 Holy Child 10th O/N
2018 Jack and Jill Challenge Course
2018 Janney 5th Ropes
2018 JCC Staff Ropes
2018 JDS 7th Ropes
2018 KinderCare Farm/Ropes
2018 Korean Retreat Teambuilding
2018 Lab Challenge Course
2018 Landon 5th Challenge Course
2018 Langley 6th Ropes
2018 Lowell 5th O/N
2018 Madeira Alumni Wknd Ropes
2018 Mclean 5th Ropes 1
2018 Mclean 6th Ropes 2
2018 Mclean 8th Raft
2018 MCOGL Rafting
2018 NCS/St Albans 8th Challenge Course
2018 OLV MS Ropes
2018 PPA Premier Team Rafting
2018 PPA Water Day
2018 Sidwell MS Ropes and Cave
2018 St Andrews 5th Ropes
2018 St Francis Teacher Challenge Course
2018 Stone Ridge 8th Ropes
2018 Temple Rodef Challenge Course
2018 Troop 52 Kayaking
2018 Troop 5729 SUP
7-10-2018 JCC Zahav Rafting
7-16-2018 JCC Climb
7-19-20-2018 JCC Zahav O/N
7-31-2018 JCC Zahav Water Day
8-1-2018 JCC Kachol Ropes
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Relationship to Participant
Parent/Guardian First Name
Parent/Guardian Last Name
Mailing Zip/Postal Code
I acknowledge and agree that myself or my child is participating in a Calleva program. I fully understand and agree that there is the possibility of an accident or other physical injury and agree to assume the risk of such injury and further agree that Calleva, Inc., shall have no responsibility or liability in the event that I or the minor child for whom I am responsible suffer(s) any injury or harm.
I declare that (I am)/ (the minor child for whom I am responsible is) in good physical health and believe that is able without reservations or limited conditions to physically withstand and cope with the indicated rigors of this program.
If I am an adult Particpant or the Parent of a minor Student I agree, for myself and on behalf of the minor student for whom I sign as follows: I understand and acknowledge that the description above the inherent risks of Calleva's activities is not complete and that other, including unknown or unanticipated, risks, inherent and otherwise, may result in property loss, injury, illness or death. I acknowledge that my participation in this Calleva experience is purely voluntary, and I wish to participate in spite of and with knowledge of the inherent and other risks involved. I acknowledge and assume the inherent risks described above and all other inherent risks of my Calleva activity. In addition, except for an injury or other loss which occurs on lands whose rules or regulations prohibit my doing so as a matter of law, I expressly assume ALL risks of my Calleva activity, inherent or otherwise, and whether or not described above.
AGREEMENT OF RELEASE AND INDEMNITY:
On behalf of myself and any minor child for whom I sign, I hereby release and hold harmless Calleva and its owners, directors, officers, employees, contractors and other agents (each a “Released Party”) from all liabilities, injuries, damage, causes of action, complaints, suits, claims, obligations, costs, losses and all other legal responsibilities (collectively, “Claims”) suffered by me or such minor child and arising from participation in any activity of Calleva unless such Claim is caused by the gross negligence, malice or willful misconduct of the Released Party against whom the Claim is brought. I specifically agree not to institute or cooperate with any Claim in violation of the foregoing sentence. I further agree to indemnify and defend Calleva or any other Released Party against any Claim that may be brought against it by any person if such Claim is attributable to any of my or my minor child’s actions or failure to act, is such actions or failure to act constituted gross negligence, malice or willful misconduct on the party of my child or me.
THE PARTICIPANT HAS READ THIS PAGE AND UNDERSTANDS AND VOLUNTARILY AGREES TO ITS TERMS, WHICH SHALL BE BINDING UPON THEM, THEIR HEIRS, ESTATE, EXECUTORS AND ADMINISTRATORS.
(Check box if Applicable): We hereby allow Calleva to use photographs or images of me/my child for appropriate promotional material related to the activity the participant will be enrolled in.
Participant/Responsible Adult Electronic Signature
Date of Electronic Signature
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