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12 Characters
1 Uppercase letter
1 Lowercase letter
1 Number
1 Special character
Hidden fields
Date
Organization
Course Start Date
Medical Record Length
Salesforce Course ID (Hidden)
Program Type
Population
Program Line
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Insight
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Enrollment Fill Rate
Individual Student Tuition
Calculated Tuition
Course Discount
Course Code
Program:
Hybrid WFR 5 Day Cert 5/6 to 5/10/2025
THIS COURSE IS CURRENTLY FULLY ENROLLED
You are still welcome to submit an application. All new applications will be placed on the course Waitlist. Should any new spots become available, you may be offered an opportunity to participate in the course.
First Name
Middle Name
Last Name
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Jr, Sr, III, etc.
Preferred First Name
Date of Birth
MM/DD/YYYY
Age Valid?
Age Valid
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The date of birth you have entered is formatted incorrectly. Please try again using a fully formatted date (for example, 04/05/2008).
Age Range
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Under 18
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Pronouns
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They/Them
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I use all pronouns
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Other Pronouns
Gender
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Woman or girl (female-identifying individuals including cisgender and transgender)
Man or boy (male-identifying individuals including cisgender and transgender)
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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
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Prefer not to Answer
African American
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Country
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United States
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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
Applicant Mobile Phone (optional if under 18)
Applicant Excluded from HH Name and Greetings (hidden)
Yes
No
Impossible to Answer Question
Parent/Guardian Information (Required If Applicant is Under the Age of 18)
What is this parent/guardian's relationship to the applicant?
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Parent
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Other
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
Does this parent/guardian live at the same address as the applicant?
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Yes
No
Country
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United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos ( Keeling ) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Côte d ' Ivoire
Croatia ( Hrvatska )
Cuba
Cyprus
Czech Republic
Congo ( DRC )
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands ( Islas Malvinas )
Faroe Islands
Fiji Islands
Finland
France
French Guiana
French Polynesia
French Southern and Antarctic Lands
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Honduras
Hong Kong SAR
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao SAR
Macedonia, Former Yugoslav Republic of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russia
Rwanda
Samoa
San Marino
São Tomé and Prìncipe
Saudi Arabia
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
Spain
Sri Lanka
St. Helena
St. Kitts and Nevis
St. Lucia
St. Pierre and Miquelon
St. Vincent and the Grenadines
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
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Virgin Islands ( British )
Virgin Islands
Wallis and Futuna
Yemen
Zambia
Zimbabwe
Street Address
City
State/Province
Please select...
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
State/Province
ZIP/Postal Code
Emergency Contact
What is the emergency contact's relationship to the applicant?
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Parent
Grandparent
Guardian
Spouse
Other
Please specify the emergency contact's relationship to the applicant.
Full Name
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Applicant Medical Information
Outward Bound courses are physically and emotionally demanding. Thus, it would be helpful for our staff to know the following information about the participant’s health; however, it is your responsibility to determine if you (or your child) can participate safely. The information below will be provided to medical personnel in the event of an emergency. Outward Bound strives to make reasonable accommodations for student medical and physical conditions. If you (or your child) need an accommodation, please let us know so we can assist you.
Outward Bound courses are physically and emotionally demanding. Thus, it would be helpful for our staff to know the following information about the participant’s health; however, it is your responsibility to determine if you can participate safely. The information below will be provided to medical personnel in the event of an emergency. Outward Bound strives to make reasonable accommodations for student medical and physical conditions. If you need an accommodation, please let us know so we can assist you.
Participant Height (Feet)
Participant Height (Inches)
Participant Weight (Lbs)
Do you have any Dietary Restrictions and/or Food Allergies?
Yes
No
Please explain your Dietary Restriction and/or Allergy:
Has the participant experienced an asthma attack at any time in their life?
Yes
No
Asthma symptoms, management, and/or restrictions
Has the participant ever been diagnosed with type I or type II diabetes?
Yes
No
Diabetes symptoms, management, and/or restrictions
Has the participant ever received medical treatment for angina, a heart attack, or any type of heart disorder/disease?
Yes
No
Heart-related symptoms, management, and/or restrictions
Has the participant ever been diagnosed with or are they currently being treated for high blood pressure?
Yes
No
High blood pressure symptoms, management, and/or restrictions
Has the participant ever seen a medical professional following a seizure, or is currently being treated for any type of seizure disorder?
Yes
No
Seizure symptoms, management, and/or restrictions
Is the participant currently pregnant?
Yes
No
Pregnancy symptoms, management, and/or restrictions
Has the participant ever visited a medical professional for a serious allergic reaction, or have they ever been given a shot of epinephrine for an allergy or anaphylaxis?
Yes
No
Allergy symptoms, management, and/or restrictions
Is there anything else you would like us to know about the participant’s health or physical condition that might affect their participation? Please leave this blank if there is no other information.
If you answered ‘yes’ to any of the above questions, Outward Bound strongly recommends that you consult with the participant’s medical provider prior to participating on the course. Our course advisors are also available to answer any questions that you might have about the activities, to help you make a decision.
Dietary Summary
Asthma Summary
Diabetes Summary
Heart Summary
Blood Pressure Summary
Seizure Summary
Pregnancy Summary
Allergy Summary
Other Summary
One Page Medical Summary
WFR Information
Are you employed with Hurricane Island Outward Bound School?
Yes
No
Is this...
A Re-Certification
A New Certification
Which certification is being Re-Certified?
Wilderness First Responder
Wilderness Advanced First Aid
WEMS Upgrades
Other
Other:
Previous Certifying Organization:
Expiration Date of Previous Certification:
Do you have any Dietary Restrictions and/or Food Allergies?
Yes
No
Please explain:
Will you need any of the following accommodations?
Cabin Bunk (spaces distributed on first come/first served basis)
Tent Space
Car Camping Spot
Other
Other:
Any other questions or concerns?
Liability Release
Hidden Control Fields
Impossible
Choice A
Org Name
Course ID
Start Date
Liability Form ID
Liability language
<p><strong style="font-size: 14px; font-family: sans-serif;">This agreement is effective for all Outward Bound courses and program activities starting in the year indicated above.</strong></p><p> </p><p><strong style="font-size: 14px; font-family: sans-serif;">IMPORTANT: Please read this carefully. This document is a legally binding contract. Your signature below indicates that you have read and understand every part of this agreement and that you agree to be bound by all of its terms without limitation.</strong></p><p> </p><p><strong style="font-size: 14px; font-family: sans-serif;">As consideration for allowing me to participate in the course, program, and activities (collectively “OB Activities”) of Outward Bound (“OB”), I agree, on my behalf and on behalf of my heirs and survivors, to the following:</strong></p><p> </p><p><strong style="font-size: 14px; font-family: sans-serif;"><u>My Suitability to Participate:</u></strong><span style="font-size: 14px; font-family: sans-serif;"> I am aware of and familiar with the OB Activities in which I may participate. I have had ample opportunity to ask questions about the OB Activities and their risks. I have accurately completed OB’s application and medical forms. I have no mental or physical limitations that might affect my ability to participate in OB Activities that I have not disclosed to OB in writing. I understand and agree that I must obey all OB rules, regulations, and policies.</span></p><p> </p><p><strong style="font-size: 14px; font-family: sans-serif;"><u>My Assumption of Risks:</u></strong><span style="font-size: 14px; font-family: sans-serif;"> My participation in OB Activities is purely voluntary. These activities may be physically, mentally, and emotionally challenging. I understand it is impossible to identify all OB Activities in which I may participate. I am aware that these activities could include, but not be limited to: hiking, backpacking, skiing, snowboarding, dogsledding, 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 and structures suspended off the ground, potentially at great heights, swinging or traveling by a cable and pulleys and other such activities); rock, ice, wall or tower climbing; water activities including flat water or whitewater boating, rafting, canoeing, or kayaking; ocean sailing or sea kayaking; surfing, snorkeling, SCUBA, or swimming; river crossings; bicycling (including mountain biking); mountaineering (snow, glacier, or ice travel or travel at high altitude); and running.</span></p><p> </p><p><span style="font-size: 14px; font-family: sans-serif;">OB Activities may be modified for any reason, including convenience, weather, or unexpected conditions or events. Activities may take place in the United States or in foreign countries and may be supervised or unsupervised. I may have time alone in remote areas. I may also be in areas with exposure to individuals who are not under OB’s supervision or control.</span></p><p> </p><p><span style="font-size: 14px; font-family: sans-serif;">OB Activities may require that I travel by van, car, and public or chartered transport on public or private roads and over remote and unpredictable terrain with steep roads and slippery slopes.</span></p><p> </p><p><span style="font-size: 14px; font-family: sans-serif;">I understand that due to the location and nature of some OB Activities, cell phone coverage and other forms of communication may be unavailable and prompt medical attention, evacuation, and transport, including transport by ambulance, air, and other emergency means, may be significantly delayed.</span></p><p> </p><p><span style="font-size: 14px; font-family: sans-serif;">It is impossible to know or list every risk which will depend on the OB Activities. Some, but not all, of the risks I 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, venomous 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; communicable disease; physical contact with other participants or other individuals; and other natural or human-caused hazards. Another risk is the potential misjudgment by OB instructors, volunteers, other staff members, co-participants or contractors related to my participation, including but not limited to decisions regarding my physical condition and capabilities, weather, water, terrain, route, or medical treatment. All these risks are inherent to the OB Activities, which means that they cannot be changed or eliminated without altering the essential elements of the activity.</span></p><p> </p><p><strong style="font-size: 14px; font-family: sans-serif;">I acknowledge that my participation in OB Activities involves inherent risks and other risks, hazards, and dangers that can cause or lead to death, injury, illness, property damage, mental or emotional trauma, or disability. I understand that OB cannot ensure my safety and does not seek to eliminate all these risks, in part, because they facilitate the educational and other objectives of the OB Activities. <u>I agree to assume all the risks of my participation in OB Activities, whether inherent or not and whether described above or not.</u></strong></p><p> </p><p><strong style="font-size: 14px; font-family: sans-serif;"><u>My Release of Liability and Promise not to Sue OB:</u></strong><span style="font-size: 14px; font-family: sans-serif;"> </span><strong style="font-size: 14px; font-family: sans-serif;">On behalf of myself and my heirs and survivors, I hereby forever release, waive, and discharge Hurricane Island Outward Bound School, Outward Bound Services Group II, LLC, Outward Bound, Inc., other Outward Bound chartered Schools, and each of their 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 arising from or related to my enrollment or participation in any OB Activity, including the use of any equipment or facilities during OB Activities. 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).</strong></p><p> </p><p><strong style="font-size: 14px; font-family: sans-serif;"><u>My Agreement to Indemnify OB:</u> I further agree to defend, indemnify (to pay or reimburse for money any Released Party is required to pay, including attorney’s fees and costs), and hold harmless the Released Parties with respect to any and all claims related to or arising from my enrollment or participation in the OB Activities including the use of equipment or facilities and including claims that OB instructors, staff, or volunteers were negligent. This includes claims for damage or injury that are finally determined to have been caused by my 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.</strong></p><p> </p><p><strong style="font-size: 14px; font-family: sans-serif;"><u>OB Activities on Federal Lands: </u></strong><span style="font-size: 14px; font-family: sans-serif;"> I understand that OB Activities may occur on lands owned by the United States (e.g., National Parks, Forest Service, Bureau of Land Management) (hereinafter “Federal Lands”). The United States may not allow 1) for the assumption of risks on Federal Lands other than the inherent risks or 2) for the release of liability or indemnification for claims of negligence. To the extent that such a prohibition is in writing 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 any and all OB Activities which do not take place on Federal Lands.</span></p><p> </p><p><strong style="font-size: 14px; font-family: sans-serif;"><u>Right to Refuse or Expel and Early Departure:</u></strong><span style="font-size: 14px; font-family: sans-serif;"> I understand that OB reserves and retains the right, at its sole discretion, to cancel, reject, and/or refuse my admission and/or participation in OB Activities and that OB may expel me for any reason at any time. I further understand that OB may determine that due to medical, behavioral, or emotional reasons, I may be required to terminate participation in the OB Activities. I further understand that if OB exercises these rights all deposits, fees, tuition, or other monies paid to OB are non-refundable. I also agree that I will be financially responsible for all costs related to my early departure from the OB Activities.</span></p><p> </p><p><strong style="font-size: 14px; font-family: sans-serif;"><u>Photographic/Video Release:</u></strong><span style="font-size: 14px; font-family: sans-serif;"> I hereby authorize OB and its Staff to take photographs or videos that may include me in them and to use the same for the promotion of OB, including websites, social media, brochures, newsletters, or in any other OB publication or promotion.</span></p><p> </p><p><strong style="font-size: 14px; font-family: sans-serif;"><u>Choice of Law and Forum Selection:</u></strong><span style="font-size: 14px; font-family: sans-serif;"> I agree that the substantive state law of Maine (but not any law that would apply the laws of another jurisdiction) governs this document and any dispute or suit arising from or related to my enrollment or participation in the OB Activities. Any mediation, suit, or other proceeding must be filed or brought only in the state court with proper jurisdiction located in Knox County, Maine.</span></p><p> </p><p><strong style="font-size: 14px; font-family: sans-serif;"><u>Severance:</u></strong><span style="font-size: 14px; font-family: sans-serif;"> The assumption of risk, release, promise not to sue, 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.</span></p><p> </p><p><strong style="font-size: 14px; font-family: sans-serif;"><u>Integration:</u> </strong><span style="font-size: 14px; font-family: sans-serif;">I understand and agree that this Agreement is a fully integrated contract and supersedes any and all oral and/or written expressions by OB about my participation in OB Activities</span></p><p> </p><p><strong style="font-size: 14px; font-family: sans-serif;">I HAVE CAREFULLY READ, UNDERSTAND, AND VOLUNTARILY SIGN THIS DOCUMENT. I UNDERSTAND THAT I AM SURRENDERING CERTAIN LEGAL RIGHTS. I AGREE THAT THIS AGREEMENT SHALL BE BINDING ON ME AND MY HEIRS AND SURVIVORS. I AGREE TO ALL TERMS AND CONDITIONS IN THIS DOCUMENT.</strong></p><p> </p><p><em style="font-size: 14px; font-family: sans-serif;">By electronically typing my signature below, I agree that it has the same legal effect as my handwritten signature. My electronic signature applies to all pages and terms of this liability release.</em></p>
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 Signature
Invalid 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 Signature
Invalid Participant Signature
Invalid Signature Placeholder Message
Don't allow submit
Payment
Description for Authorize
Credit/Debit Card Information
Balance Due
First Name
Last Name
Card Number
Expiration Month
Expiration Year
CVV Code
Billing Zip Code
Email Address
Authnet_Hidden_Fields
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