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Outdoor Outreach Participant Waiver, Registration and Medical Form / COVID-19 Agreement and Screening

PARTICIPANT AGREEMENT, RELEASE AND ASSUMPTION OF RISK

In consideration of the services of Outdoor Outreach, their agents, owners, officers, volunteers, participants, and employees, as well as the organizations, schools, school districts sponsoring participation, and all other persons or entities acting in any capacity on their behalf in the delivery of the services (hereinafter collectively referred to as "OO"). I hereby agree to release, indemnify, and discharge OO, on behalf of myself, my spouse, my children, my parents, my heirs, assigns, personal representatives and estate as follows: 

I acknowledge that my/my child’s/ward’s participation in hiking, walking, biking, rock climbing, skiing and/or snowboarding, paddle boarding, swimming, surfing, snorkeling and other adventure based activities entails known and unanticipated risks that could result in physical or emotional injury, paralysis, death, or damage to myself, to property, or to third parties. I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activity. The risks include, among other things: Slips and falls; accidents involving other bicycles or vehicles; collision with fixed or movable objects; injuries or accidents involving contact with the bicycle; falls from the bicycle; the negligence of other operators of motor vehicles or myself; cuts, bruises, abrasions, and concussions; the use of climbing ropes and equipment; rope burns; weather conditions; falling objects; water hazards; falling into the water, and accidental drowning; exhaustion; exposure to temperature and weather extremes which could cause hypothermia, hyperthermia (heat related illnesses), heat exhaustion, sunburn, dehydration; and exposure to potentially dangerous wild animals, insect bites, aggressive and/or poisonous marine life and hazardous plant life; equipment failure; and improper lifting or carrying; hidden obstacles by snow including crevasses, ice and snow cornices, tree wells, tree stumps, creeks rocks and boulders, below the snow surface; loss or damage to equipment being used; being lost or separated from their guides or companions by traveling in forested areas, rugged terrain, or bad weather; exposure to altitude and cold including hypothermia, frostbite, acute mountain sickness, exhaustion, cerebral and pulmonary edema; my own physical condition, and the physical exertion associated with this activity; the condition of roads, terrain, or highways and accidents connected with their use. Communication in this mountain terrain is always difficult and in the event of an accident, rescue and medical treatment may not be immediately available. 

Furthermore, OO employees have difficult jobs to perform. They seek safety, but they are not infallible. They might be unaware of a participant's fitness or abilities. They might misjudge the weather or other environmental conditions. They may give incomplete warnings or instructions, and the equipment being used might malfunction. 

1. I expressly agree and promise to accept and assume all of the risks existing in this activity. My/my child’s/ward’s participation in this activity is purely voluntary, and I elect to/ to allow them to participate in spite of the risks. 

2. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless OO from any and all claims, demands, or causes of action, which are in any way connected with my/my child’s/ward’s participation in this activity or my/my child’s/ward’s use of OO 's equipment or facilities, including any such claims which allege negligent acts or omissions of OO

3. Should OO or anyone acting on their behalf, be required to incur attorney's fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs. 

4. I certify that I have adequate insurance to cover any injury or damage I/my child/ward may cause or suffer while participating, or else I agree to bear the costs of such injury or damage myself. I further certify that I am willing to assume the risk of any medical or physical condition I may have. 

5. In the event that I file a lawsuit against OO, I agree to do so solely in the state of California, and I further agree that the substantive law of that state shall apply in that action without regard to the conflict of law rules of that state. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining document shall remain in full force and effect. 


By signing this document, I acknowledge that if anyone is hurt or property is damaged during my child’s/ward’s participation in this activity, I may be found by a court of law to have waived my right to maintain a lawsuit against OO on the basis of any claim from which I have released them herein. I have had sufficient opportunity to read this entire document. I have read and understood it, and I agree to be bound by its terms.

Outdoor Outreach COVID-19 Pre Trip Agreement

The health and wellness of everyone participating is our top priority. We are adapting our programs to local and state health guidelines, as new updates are released, we will continue to stay up to date on our practices and policies.

I OR the parent/guardian (if participant is under 18 years old) am aware participating in Outdoor Outreach activities entails certain risks. By voluntarily engaging in in-person activities, I am willing to assume the associated risks. I agree to abide by the COVID-19 procedures outlined by Outdoor Outreach, observe local and state government policies and regulations related to exposure prevention, as well as CDC guidelines. I will take all necessary and reasonable precautions to avoid COVID-19 exposure; however, I acknowledge that neither I, nor Outdoor Outreach, can eliminate all risks created by the COVID-19 pandemic, including the potential for exposure to the virus while at, or traveling to, an Outdoor Outreach activity, regardless of whether I/they adhere to the health and safety procedures established by local governments and the CDC, or other recommended hygiene and social distancing practices.

  • If on the day of a program, the participant exhibits symptoms relating to COVID-19, parent/guardian (if under 18 years old) will be contacted to pick up the participant from the activity location. 

  • If a participant exhibits symptoms relating to COVID-19 within 48 hours of the completion of a program the participant OR parent/guardian (if under 18 years of age) agrees to inform Outdoor Outreach as soon as possible.






Example: 123 Balboa Ave.




PARENT'S OR GUARDIAN'S ADDITIONAL INDEMNIFICATION

(Must be completed for participants under the age of 18)

In consideration of the participant named above being permitted by OO to participate in its activities and to use its equipment and facilities, I further agree to indemnify and hold harmless OO from any and all claims which are brought by, or on behalf of Minor, and which are in any way connected with such use or participation by Minor.


PARENT'S OR GUARDIAN'S AUTHORIZATION FOR TREATMENT

(Must be completed for participants under the age of 18)

Authorization for treatment: I hereby give permission to the medical personnel selected by OO staff to order x-rays, routine tests, treatment to and provide necessary transportation for my child. In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by the OO staff to secure and administer treatment including hospitalization, for my child as named above.



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Outdoor Outreach Participant Waiver, Registration and Medical Form / COVID-19 Agreement and Screening

Please complete the forms below. They are required for participation in Outdoor Outreach programs.
This information is strictly for the use of Outdoor Outreach (admin and trip leaders) and emergency personnel. The information you provide is strictly confidential and will not be released without your knowledge and consent.
Photo and Video Consent/Release
From time to time we would like to share some of the moments we have captured from our events on the Outdoor Outreach website, our newsletter or with the larger community.

Participant General Information









Race/Ethnicity: We want to make sure that all members of our community, regardless of race and/or ethnicity, are recognized and supported by our services. Please share information so we can track who our services are reaching. Please select all that apply 


Parent/Guardian Information











Military Status (for Outdoor Outreach Military Initiative Programs)



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Outdoor Outreach Participant Waiver, Registration and Medical Form / COVID-19 Agreement and Screening

Confidential
To be completed by the applicant or their parent/guardian if under 18
This medical record provides us with information for trip safety and emergency situations. By requesting this medical history, we do not imply that we have the expertise to assess your physical condition, or your ability to participate safely in this trip. This determination of ability to participate must be made by you, the participant, in concert with your physician. 
Emergency Contact Information 
#1 Emergency Contact (parent/guardian if under 18)






#2 Emergency Contact (parent/guardian if under 18)






Medical Insurance Information (if available, not required to participate) 
Each participant is responsible for medical expenses resulting from treatment of any illness or accident during a program. 



Participant Personal Information
Height, weight and sizing information is used to inform our staff of the gear sizes needed to accommodate each participant.








Participant General Health





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Outdoor Outreach Participant Waiver, Registration and Medical Form / COVID-19 Agreement and Screening

Past and Present Medical Conditions

Condition
and Symptoms
Date of Last Occurrence
(if applicable)
Treatment for Last Occurrence
(if applicable)
1:
2:
3:
4:
5:
Allergies





If you are currently prescribed epinephrine we require that you bring your medication with you on all programs.




Medications





Please describe your current prescription and/or non-prescription medications:
(excluding birth control meds)
Medication Name Dosage Condition Med is Treating Side effects
(if applicable)
Med 1
Med 2
Med 3
Hospitalizations/Emergencies/Urgent Care


ESSENTIAL ELIGIBILITY CRITERIA
Outdoor Outreach programs and activities are open to individuals who meet the Essential Eligibility Criteria (EEC) here within. Outdoor Outreach is not intended to be rehabilitative or clinically therapeutic and does not specialize in serving those with special needs including; mental, emotional, social, or behavioral difficulties. If a youth participant is unable to meet some of the criteria relating to their chosen activity/ies, please contact us; we may be able to make reasonable accommodations unless it would alter the fundamental nature of the course, would compromise the participant’s safety, the safety of other participants or staff, or would place an undue financial or administrative burden on Outdoor Outreach.
  • Breathe independently (i.e., not require medical devices to sustain breathing).
  • Independently hold head upright without neck / head support.
  • Manage personal care and personal needs (maintaining adequate nutrition and hydration, dressing appropriately for environmental conditions, maintaining personal hygiene, and managing known medical conditions, etc.) either independently or with assistance of a companion, excluding Outdoor Outreach instructors.
  • Must have the ability to follow visual and/or verbal instruction independently or with the assistance of a companion, excluding Outdoor Outreach instructors.
  • Must have the ability to move about the location of the program, either independently or with the assistance of a companion, excluding Outdoor Outreach instructors.
  • Perceive and comprehend the inherent risks of the activity, including, but not limited to, the ones identified by Outdoor Outreach Instructors and to adhere to safety policies and procedures even when instructors are not present. 
  • Ability to stay alert and reasonably engaged for the duration of the program.
  • Effectively signal or notify Instructors or other students of personal distress, injury or need for assistance. 
  • Able to refrain from inappropriate physical touch and behavior.
  • Able to refrain from being under the influence or in possession of alcohol, tobacco, controlled substances, and any misuse of prescription or over the counter drugs for the duration of an outing. 
  • Must have the ability to withstand exposure to the outdoors, including but not limited to cold, sun, heat and insects, for the duration of the program.
  • Must have the ability to withstand physical impact, relevant to the potential of each activity, of a minor fall, bump, scrape, etc. with minimal consequence to health or medical condition.
  • Must be able to adapt to venue terrain, and changes in terrain brought on by inclement weather and changing light conditions. 

In order to use Outdoor Outreach transportation: Participants must be able to enter and exit vehicles independently or with the assistance of a companion. Or otherwise use an alternatives means of transportation to travel to the activity location


If you are unsure if accommodations need to be made, please email info@outdooroutreach.org


For Activity-Specific Eligibility Criteria, please visit our Safety and Risk Management website page.