Consent and Personal Release Form                                                                                                      

 

Soul Quest Canada

PARTICIPANT AGREEMENT, RELEASE AND ASSUMPTION OF RISK

 

In consideration of the services of Soul Quest Canada, their agents, owners, officers, volunteers, participants, employees, and all other persons or entities acting in any capacity on their behalf (hereinafter collectively referred to as "SQC"), I hereby agree to release, indemnify, and discharge SQC, on behalf of myself, my spouse, my children, my parents, my heirs, assigns, personal representative and estate as follows:

 

1. I acknowledge that hiking, camping and backpacking 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, but are not limited to, slipping and falling; falling objects; water hazards; exhaustion; exposure to temperature and weather extremes which could cause hypothermia, hyperthermia (heat related illnesses), heat exhaustion, sunburn, dehydration, exposure to potentially dangerous wild animals, insect bites, and hazardous plant life; accidents or illness can occur in remote places without medical facilities and emergency treatment or other services rendered; consumption of food or drink; equipment failure; improper lifting or carrying; my own physical condition, and the physical exertion associated with this activity.

Furthermore, SQC 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.

 

2. I expressly agree and promise to accept and assume all of the risks existing in this activity. My participation in this activity is purely voluntary and I elect to participate in spite of the risks.

 

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

 

4. Should SQC 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.

 

5. I certify that I have adequate insurance to cover any injury or damage I 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.

 

By signing this document, I acknowledge that if anyone is hurt or property is damaged during my participation in this activity, I may be found by a court of law to have waived my right to maintain a lawsuit against SQC 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.

 

If you wish to sign this form with an electronic signature (type in your name below) and send it back to us via email, you agree that your electronic signature is your signed acknowledgement that you have read and agree to all of the stipulations listed above.

 

Signature of Participant: ___________________

Print Name: ___________________

DOB: _____________________

Date: ___________________

Name of Program: ___________________

Contact Info Address: ___________________ ___________________

Cell: ___________________

Other #: ___________________

 

In case of injury or illness, contact:

Name: ___________________

Relationship: ___________________

Address: ___________________

Phone: ___________________

Work Phone: ___________________

Cell phone: ___________________

 

Please complete, scan and return to rosinjessica7@gmail.com.

Or Mail to Greatlife Psychology Centre: Athabasca Professional Centre - #206, 80 Chippewa Road, Sherwood Park, T8A 4W6.