Form Center

2. 
3. YMCA of the Rockies Outdoor Education
   Student Liability Release
5. By means of this agreement the undersigned individually, and on behalf of the participant child release, waive and discharge any and all claims against YMCA of the Rockies, Estes Park Center, Outdoor Education Department for any and all liability for any and all loss or damage caused by negligent acts or omissions of YMCA of the Rockies.
7. School:*
8. Student Name:*
10. Phone:*
11. Race:
12. Sex:*
13. Date of Birth:*
    Date of Birth:
15. Address:
17. City:*
18. State:*
19. Zip:*
23. Acknowledgement of risk, waiver, release and indemnification
25. To Parent or Guardian:
    This permission form must be filled out completely and returned to your child’s teacher in order for your child to attend activities at the YMCA of the Rockies. No child will be permitted to participate in activities at the YMCA of the Rockies without the complete and signed form.
27. We, the Parents/Guardians of below,*
    individually and on behalf of the participant child, do hereby release the YMCA of the Rockies, Outdoor Education Instructors, Outdoor Education Department from any damages as a result of any sickness or injury during the duration of their Outdoor Education experience. We further understand and acknowledge that certain adventure activities, high ropes, walking on uneven trails, etc. have an increased risk of injury.
29. Certain risks cannot be eliminated due to the Center’s mountain setting and without destroying the unique character of those activities. The same elements that contribute to the character of these activities can be the cause of loss or damage to your property, accidental injury or illness, or in extreme cases, permanent trauma or death including if caused by negligence.
31. I HAVE CAREFULLY READ THIS AGREEMENT AND UNDERSTANTD IT TO BE A RELEASE OF ALL CLAIMS AND CAUSES OF ACTION FOR THE CHILD PARTICIPANT’S INJURY OR DEATH OR DAMAGE TO THE CHILD PARTICIPANT’S PROPERTY THAT OCCURS WHILE PARTICIPATING IN OUTDOOR EDUCATION EXPERIENCES AND IT OBLIGATES ME TO INDEMNIFY THE PARTIES NAMED FOR ANY LIABILITY FOR INJURY OR DEATH OF ANY PERSON AND DAMAGE TO PROPERTY CAUSED BY THE CHILD PARTICIPANT’S NEGLIGENT OR INTENTIONAL ACT OR OMISSION.
33. Student Name:*
34. I,*

    1. Accept
35. Date:*
    Date:
37. Parent/Guardian Name:*
38. I,*

    1. Accept
39. Date:*
    Date:
41. Parent/Guardian Name:
42. I,

    1. Accept
43. Date:
    Date:
Leave This Blank:


45. 1. Receive an email copy of this form.
46. Email address

    This field is not part of the form submission.

47. Submit

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