Course Information

Please select your language.

Let's get started with your application! You will need about 10 minutes to complete the application.

For this application, we will be asking for the following information:

Contact information for applicant (and parent/guardian information for participants under 18)
Local emergency contact (for participants 18 and over)
Basic medical information
Liability release form signed by applicant (and parent/guardian for participants under 18)

Program Line

Salesforce Course ID (Hidden)

Secondary Parent/Guardian ID (Hidden)

Course Start Date

Organization

Date

Welcome Message

Welcome Participant & Family,

The staff and instructors at Philadelphia Outward Bound School (POBS) look forward to seeing you on your upcoming Insight Day at the challenge course!

What is Outward Bound? Outward Bound is the leading provider of experiential and outdoor education programs for youth and adults. It is a national network of Schools providing hundreds of courses in wilderness and urban environments.

Our mission is to change lives through challenge and discovery. We do this by conducting safe, experiential learning and adventure-based courses. Courses are structured to encourage self-discovery and growth, and inspire confidence, self-reliance, leadership, character, compassion and service to self, others and the environment. Using a variety of outdoor activities as vehicles for learning, participants are challenged to build relationships and foster teamwork, and exercise leadership, communication, and problem-solving skills in an exciting and challenging environment – all while having fun with peers and colleagues.

What is an Insight Program? Insight is a single-day, outdoor, experiential learning and team building opportunity. During the approximate 5-6 hour day, participants use problem solving, constructive communication and team-oriented approaches to work collaboratively and navigate the day. Participants are in the natural world, meeting challenges, practicing leadership, managing risk, and working closely with their group. Our goal is to have participants apply their experiences and learning back into their educational and work environments and in their daily lives.

What should participants bring & wear? The most important things to bring - a good attitude, open mind and adventurous spirit. Outward Bound provides all necessary technical equipment. Participants must wear closed-toed, laced shoes and dress appropriate for the weather and an active day outside. Electronic devices are not permitted during the program.

Covid-19 Mitigation? Participants will be asked to follow current CDC recommendations around mask wearing and distancing. Current guidelines will be discussed as a part of course planning with the school or organization.

Questions or Concerns? Please contact Associate Director of Admissions & Medical Screening, Aisha Burrell at 215-372- 8929.

We look forward to seeing you very soon!

Lauren Stables & Aisha Burrell

Applicant Information

First, we'll collect some information about the applicant.

First Name

Middle Name

Last Name

Suffix

Jr, Sr, III, etc.

Preferred First Name

Date of Birth

MM/DD/YYYY

Age Valid?

Age ValidAge Invalid

The date of birth you have entered is formatted incorrectly. Please try again using a fully formatted date (for example, 04/05/2008).

Impossible to Answer Question

Age Range

Gender

Understanding an applicant's gender identity helps our staff provide the best support, both in preparation for course and on course. Options are included for applicants who do not identify exclusively as male or female.

Please specify your preferred gender identity.

Ethnic Background

Country

Street Address

City

State/Province

ZIP/Postal Code

Applicant Email Address

Be sure to enter a valid email or the liability release will fail to process

Applicant Email Address (optional if under 18)

Applicant Mobile Phone (optional if under 18)

I give Philadelphia Outward Bound School permission to send text messages to this number

YesNo

I am a chaperone/teacher

Applicant Excluded from HH Name and Greetings (hidden)

YesNo

Parent/Guardian Information (Required If Applicant is Under the Age of 18)

What is this parent/guardian's relationship to the applicant?

Please specify this parent/guardian's relationship to the applicant.

First Name

Middle Name

Last Name

Suffix

Jr, Sr, III, etc.

Personal Email

Be sure to enter a valid email or the liability release will fail to process

Mobile Phone

I give Philadelphia Outward Bound School permission to send text messages to this number

YesNo

Does this parent/guardian live at the same address as the applicant?

Country

Street Address

City

State/Province

ZIP/Postal Code

Emergency Contact

Please list someone local who would be available to pick up the participant in case of emergency.

What is the emergency contact's relationship to the applicant?

Please specify the emergency contact's relationship to the applicant.

Full Name

Primary Phone

Other Phone

Liability Release

Hidden Control Fields

Impossible

Choice A

Org Name

Course ID

Start Date

Liability Form ID

Liability language

PARTICIPANT ACKNOWLEDGEMENT AND ASSUMPTION OF RISKS and LIABILITY RELEASE AND INDEMNITY AGREEMENT
           In consideration of the services of Philadelphia Outward Bound Center dba Outward Bound Philadelphia, and its chartering organization, Outward Bound, Inc., and its affiliated Outward Bound Services Group, and Charter Schools, (collectively referred to as “OB”), participant (and parent or legal guardian of a minor participant) acknowledges and agrees as follows:
Acknowledgment and Assumption of Risks           I understand that participant (and parents) share(s) the responsibility for participant’s safety, for managing the risks, and for determining the participant’s suitability for the program in which he/she will participate. I have accurately completed any required OB application and medical forms and have reviewed all OB program information provided to me. I agree to obey all OB rules, regulations, and policies (and have my child obey them). I have (or my child has) no mental or physical problems or limitations that might affect my (or my child’s) ability to participate that have not been disclosed to OB in writing. I have had the opportunity to ask questions about the program activities and the risks of the program in which I (or my child) will participate.           I understand and acknowledge that the program(s) in which I (or my child) will participate has risks and may be physically strenuous. It is impossible to anticipate every activity in which I (or my child) will engage. Outward Bound offers numerous courses with a wide variety of activities. The list below includes many of those activities. The activities in my (or my child’s) course will depend on the program in which I am (or my child is) enrolled but may include: hiking, backpacking, skiing, snowboarding, dog sledding, and/or snowshoeing (on and off trail); camping, including cooking over stoves, open fires or by other means; 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); rock, wall or tower climbing; physical problem-solving activities; water activities including flat water or white water boating, rafting, canoeing, or kayaking; ocean sailing or sea kayaking; surfing, snorkeling, or swimming; river crossings; bicycling (including mountain biking); mountaineering (snow, glacier or ice travel or travel at high altitude); horseback riding; jogging or stair climbing; vehicle travel and travel by public, chartered or other conveyance; rescue scenarios (real or simulated); community and other service projects that may involve using tools, power equipment, ladders, or construction materials. I understand that I (or my child) may engage in other activities not listed above. The program plan may be modified for any number of reasons, including convenience, weather, emergencies, or unexpected conditions. Activities may take place in the United States or in foreign countries and may be supervised or unsupervised. In particular, participants may have time alone in remote areas. Participants may also be in urban or other areas with exposure to individuals who are not under OB’s supervision or control.                It is impossible to know or list every risk associated with every activity. Risks will depend on the program. Some, but not all, of the risks I (or my child) may encounter include: unpredictable or harsh weather; earthquakes; lightning; exposure to extreme temperatures (high heat or extreme cold); exposure to high altitude, avalanches and rock fall; rapidly moving water including whitewater and rough seas; drowning; wild animals and marine life; disease carrying or poisonous plants, insects, animals, and marine life; improper or malfunctioning equipment; slipping, falling or being struck by objects or persons; risks caused or complicated by any mental, physical, or emotional conditions any participant may have; being separated from other participants and leaders for considerable periods; physical contact with other participants or other individuals; and other natural or man-made hazards. Another risk is the potential misjudgment by OB instructors, volunteers, other staff members, co-participants or contractors related to my (or my child’s) participation, including but not limited to decisions regarding my (or my child’s) physical condition and capabilities, weather, water, terrain, route or medical treatment. All of these risks are inherent to the activities in my OB program, which means that they cannot be changed or eliminated without altering the essential elements of the activity.           I acknowledge that participating in an OB program 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. Furthermore, activities may take place several hours or days from any medical facility or where communication, transportation, or evacuation is subject to delay. I understand that OB cannot ensure my (or my child’s) safety and does not seek to eliminate all of these risks, in part, because they facilitate the educational and other objectives of the program. I agree to assume all of the risks of the activities of my (or my child’s) OB program, whether inherent or not and whether described above or not.
Liability Release and Indemnity Agreement           I hereby forever release, waive, and discharge OB, and each of its respective agents, employees, officers, directors, trustees, independent contractors, volunteers, and all other persons or entities acting under their direction and control (collectively referred to as “the Released Parties”) from, and agree not to pursue a claim or sue the Released Parties for any liability, claim, or expense in any way associated with my (or my child’s) enrollment or participation in the OB program or the use of any equipment or facilities. Neither I nor anyone acting on my (or my child’s) behalf will make a claim against the Released Parties as a result of any injury, illness, damage, death, or loss. This release includes any losses caused or alleged to be caused, in whole or in part, by the negligence, whether active or passive, of the Released Parties to the fullest extent allowed by law (but not for gross negligence) and includes claims for injury, property damage, wrongful death, breach of contract, or any other type of suit.           I further agree to defend and indemnify the Released Parties (to pay or reimburse the Released Parties for money they are required to pay, including attorney’s fees and costs) with respect to any and all claims brought by or on behalf of me, my child, a family member, personal representative, estate, a co-participant, or any other person for any claims related to my (or my child’s) enrollment or participation in the program or my (or my child’s) use of equipment or facilities, including claims that OB instructors, staff, or volunteers were negligent. This includes claims for damage or injury that is finally determined to have been caused by my (or my child’s) negligent conduct or intentional misconduct. This indemnity includes payment for attorney’s fees and costs incurred by the Released Parties in defending a claim or suit if the claim or suit is withdrawn or where a court determines that the Released Parties are not liable for the injury or loss.           The National Park Service and certain Forest Services may not allow for the assumption of risks other than the inherent risks or for the release of liability for claims of negligence. Therefore, for activities that occur on lands controlled by these agencies where and to the extent that such a prohibition is in writing for that particular location, program, or permit at the time of the incident and found by a court of proper jurisdiction to be enforceable as a matter of law, the assumption of risk in the above paragraph is limited to assuming the inherent risks; the release of liability is inapplicable; and the indemnity agreement is limited to claims brought by or on behalf of a co-participant or person other than the student or a family member of the student. The assumption of all risks, the entire indemnity provision, and the release of liability shall remain in full force and effect for all activities or any portion of activities which do not transpire on lands controlled by these federal provisions. The indemnity provision for payment of attorney’s fees when a suit is withdrawn or where a court determines that the Released Parties are not liable applies to all activities regardless of where they take place.
Additional Provisions           I agree that the substantive law of Pennsylvania (but not any law that would apply the laws of another jurisdiction) governs this document and any dispute or suit I have (or my child has) with the Released Parties. Any mediation, suit, or other proceeding must be filed or entered into only in Pennsylvania.             The assumption of risk, release, indemnity agreement, and all other provisions in this document are intended to be interpreted and enforced to the fullest extent allowed by law. Any portion of this document deemed unlawful or unenforceable is severable and shall be stricken without any effect on the enforceability of the remaining provisions, which shall continue in full force and effect. OB has permission to use my (or my child’s) photo, image or video in promoting OB, including website and internet postings. OB reserves the right to remove any participant from the program when staff or an instructor believes, in his/her sole discretion, the participant presents a safety concern or medical risk, is disruptive, or acts in any manner detrimental to the program. If I am dismissed or depart (or my child is dismissed or departs) for any reason, I will be responsible for all costs of early departure whether for medical reasons, dismissal, personal emergencies, or otherwise.            I HAVE CAREFULLY READ, UNDERSTAND, AND VOLUNTARILY SIGN THIS DOCUMENT. I UNDERSTAND THAT I AM SURRENDERING CERTAIN LEGAL RIGHTS. I AGREE THAT THIS FORM SHALL BE BINDING ON ME, MY MINOR CHILDREN AND OTHER FAMILY MEMBERS, AND MY HEIRS, EXECUTORS, REPRESENTATIVES, AND ESTATE. I HEREBY WARRANT THAT I HAVE LEGAL AUTHORITY TO ACT ON MY CHILD’S BEHALF. I AGREE, ON MY OWN, AND ON MY CHILD’S BEHALF, TO THE TERMS AND CONDITIONS IN THIS DOCUMENT.
If participant is under the age of 18 (or if participant is a resident of Alabama and is under the age of 19) (or if participant is a resident of Mississippi and is under the age of 21) at the time this document is signed, a parent or legal guardian must sign the release in addition to the participant signing.
Form #5 POBS Long-Minor/Adult-2017

Participant Information

Course Date

Participant Name

Parent/Guardian Signature

The typed signature below is equivalent to a handwritten signature.

Parent/Guardian Signature

Parent Signature Valid?

Valid Parent SignatureInvalid Parent Signature

Invalid Signature Placeholder Message

Don't allow submit

Participant Signature

The typed signature below is equivalent to a handwritten signature.

Participant Signature

Participant Signature Valid?

Valid Participant SignatureInvalid Participant Signature

Invalid Signature Placeholder Message

Don't allow submit

Signature Debug Info

Course Information

Welcome Message

Applicant Information

Parent/Guardian Information (Required If Applicant is Under the Age of 18)

Emergency Contact

Applicant Medical Information

Liability Release