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 Barrie MS Fall Trip
2018 Barrie US Fall Trip
2018 Blessed Sac 6th Ropes
2018 Blessed Sac 7th Ropes II
2018 Blessed Sac Raft 8th
2018 BS Troop 8 Leadership O/N
2018 BSA 233 O/N
2018 Canterbury 9th O/N
2018 Chance Academy Fall Challenge Course
2018 Flint Hill 8th O/N
2018 Footer Ropes Program
2018 Furman Templeton Farm Program
2018 Hardy 7th Environmental Ed
2018 Healthy Directions Teambuilding
2018 Hill School 4th Teambuilding/Farm
2018 Holton Arms 5th Ropes
2018 Holy Child 10th O/N
2018 Holy Trinity 5th Climbing
2018 Holy Trinity 6th Fall Ropes
2018 Ideaventions Teambuilding
2018 Janney 5th Ropes
2018 JDS 7th Ropes
2018 Landon 5th Challenge Course
2018 Langley 6th Ropes
2018 Little Flower 8th Ropes
2018 Mclean 5th Ropes 1
2018 Mclean 6th Ropes 2
2018 Mclean 8th Raft
2018 NCS/St Albans 8th Challenge Course
2018 Norwood 5th O/N
2018 OLV MS Ropes
2018 Poolesville Ropes
2018 PPA Water Day
2018 Providence ES Teambuilding
2018 Rodef Shalom 7th Challenge Course
2018 Rodef Shalom 7th Challenge Course
2018 Roland Park 7th O/N
2018 Sheridan 1st Farm Trip
2018 Siena 8th Wilderness Survival
2018 Siena HS Water Splits
2018 St Albans 7th Challenge Course
2018 St Andrews 6th Water Day
2018 St Anselm's 10th Raft
2018 St Anselm's 8th Ropes
2018 St Elizabeth 7th Challenge Course
2018 St Elizabeth 8th Splits
2018 St Marys Ropes
2018 St Pats 6th & 7th Ropes
2018 St. Peters 7th and 8th Ropes
2018 Stone Ridge 8th Ropes
2018 Village School Challenge Course
2018 Wash Latin 5th Challenge Course
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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