ASSUMPTION OF RISK AND RELEASE FORM THIS IS A RELEASE OF LEGAL RIGHTS -- READ AND UNDERSTAND BEFORE SIGNING.
I grant permission for my child, or if over the age of 18 years myself, to participate in all activities including but not limited to, traveling by van, bus or other designated vehicle(s), hiking, biking, climbing, kayaking, etc. I also understand that during my participation with Backcountry Unlimited, s/he/I may be exposed to a variety of risks and hazards, foreseen or unforeseen, which cannot be eliminated without fundamentally altering the unique character of the trip. Those hazards include, but are not limited to, hiking/walking/running outside, snakes, insects, large animals, sunburn, heatstroke, dehydration, hypothermia, and other mild or serious conditions or injuries, falling and rolling rocks, drowning, lightning, and unpredictable forces of nature (including weather that may change to extreme conditions without notice).
As a condition of s/he/I participation in the trip, I acknowledge that participation is entirely voluntary and Backcountry Unlimited and its officers, employees, and agent’s do not require me to participate in the Program, but I want to do so, despite the possible dangers and risks and despite this Release. I, therefore, agree to assume and take on full responsibility myself for the risks that participation may entail. I understand and agree that Backcountry Unlimited is granted permission to authorize emergency medical treatment, if necessary, and that such action by Backcountry Unlimited shall be subject to the terms of this Agreement. I understand and agree that Backcountry Unlimited assumes no responsibility for any injury, damage or cost which might arise out of or in connection with such authorized emergency medical treatment. I have consulted with a medical doctor regarding my personal medical needs. There are no health-related reasons or problems that preclude or restrict my participation in this Program. I have arranged, through medical
insurance or otherwise, to meet all needs for payment of medical costs while I participate with Backcountry Unlimited.
I will comply with Backcountry Unlimited rules, standards and instructions for participant behavior. I understand that I am not permitted to consume alcohol, possess/use illegal substances or weapons, or engage in sexual/illicit behavior while participating in the Program. I waive and release all claims against Backcountry Unlimited that arise at a time when I am not under the direct supervision of Backcountry Unlimited or that are caused by my failure to remain under such supervision or to comply with such rules, standards, and instructions.
I agree that Backcountry Unlimited has the right to enforce the standards of conduct described above, in its sole judgment, and that it will impose sanctions, up to and including expulsion from the Program or from Backcountry Unlimited, for violating these standards or for any behavior detrimental to or incompatible with the interests, harmony, and welfare of Backcountry Unlimited, the Program, or other participants. Backcountry Unlimited has the right to make changes in the format and administration of the Program.
Backcountry Unlimited is not responsible for lost, stolen, or damaged articles. The participant/parent/guardian authorizes Backcountry Unlimited to charge their credit card in the instance of any unanticipated costs incurred outside the tuition such as medical expenses, lost or damaged gear, and/or fees related to any early departure or travel day(s). I authorize Backcountry Unlimited to have and use photographs, slides, and/or video my child/myself listed on this form for marketing and/or advertising purposes, and I hereby consent to and authorize such use without seeking remuneration.
Knowing the risks described above, and in consideration of being permitted to participate with Backcountry Unlimited, I agree, on behalf of my family, heirs, and personal representative(s), to assume all the risks and responsibilities surrounding my participation in the Program. To the maximum extent permitted by law, I release, indemnify, and covenant not to sue Backcountry Unlimited from and in the against any present or future claim, loss or liability for injury to person or property which I may suffer, or for which I may be liable to any other person, during my participation Program (including periods in transit).
I have carefully read this Release Form before signing it. I fully understand it and agree to be legally bound by it. No representations, statements, or inducements, oral or written, apart from the foregoing written statement, have been made. This agreement shall be governed by the laws of the state of Arizona, which shall be the forum for any lawsuits filed under or incident to this agreement or to the Program.
I hereby give permission to the medical personnel selected by Backcountry Unlimited administration to order x-rays, routine tests, treatment, and provide necessary transportation for myself/child. In the event of an emergency, I hereby give permission to the physician selected by Backcountry Unlimited administration to secure and administer treatment including hospitalization, for myself/child as named below.
Terms of Payment & Refund Policy:
A deposit fee is required with your Backcountry Unlimited application. Backcountry Unlimited is unable to secure your reservation until both the application and deposit have been processed. Your deposit will be applied directly to your total tuition. Final tuition payments are due before for program departs. Backcountry Unlimited reserves the right to cancel unpaid applications wherein their tuition is more than 30 days past due, with no return of fees. Along with the application and registration fee, there are additional forms required to complete the application process. Application fees will only be refunded if your teen is not offered a spot with Backcountry Unlimited due to eligibility requirements.
Cancellation charges reflect the many expenses Backcountry Unlimited cannot recover, even if you cancel due to illness, injury, or personal emergencies. These fees are not meant to be punitive. The charges made reflect the expenses Backcountry Unlimited has incurred in administering your reservation and planning for your participation. We recognize that the majority of those who cancel their reservations do so out of necessity. Please note that we do not make any refunds for any unused portion of your trip, not arriving, arriving late, or leaving the trip early.
To qualify for any refunds, we must receive notification in writing, by emailing info@backcountryunlimited.com or by mailing a letter to Backcountry Unlimited at 385 Chaparral Drive, Prescott, AZ 86301. Your cancellation date is the date the notice is received by Backcountry Unlimited in writing by email or letter. Exceptions to this policy cannot be made for any reason.
In the unfortunate event that you must cancel your trip, your refund will be determined according to the following formula: Days prior to departure Refund
- 90+ days: All but $50.00 processing fee.
- 90 - 30 days: All but the deposit
- 30 days or less: No refund
Backcountry Unlimited reserves the right to cancel or alter a trip due to unforeseen weather, unsafe conditions, low registration or other circumstances. On the rare occasion that Backcountry Unlimited must cancel a trip, all payments received to date will be refunded, including the non-refundable portion of your deposit. Backcountry Unlimited is not responsible for expenses incurred in preparation for any canceled trips, including but not limited to airplane tickets, Gear, etc.
Arriving in Good Health: If you have a fever or are feeling under the weather on the schedule trip day or have been exposed to contagious illness, please stay at home until you’re ready for the trip and/or your doctor tells you’re no longer contagious. We can often arrange for a different pickup city along the way.
Behavior Expectations: The primary mission of Backcountry Unlimited is to provide an environment in which participants are comfortable being themselves, trying new things and developing confidence. To set this tone, participants and staff establish a “Full Value Contract” shortly after everyone has settled in. The most important thing that we want participants to take away from this “Full Value Contract” is respect for ourselves, each other, and the environment. Please arrive open and ready to work with others. If a participant leaves the group either voluntarily or is sent home by an authorized Backcountry Unlimited employee, every effort will be made to contact the parent/guardian or emergency contact of the participant. We reserve the right to initiate the logistical process of the teen’s departure if the parent/guardian and the emergency contacts cannot be reached. In order to ensure a positive experience for you and the other participants, it’s essential that all participants are willing to agree to the following “non-negotiable” rules:
- Participants will NOT undertake any actions that involve danger to one’s self or others.
- Participants will NOT use or possess any illegal substances.
- Participants will NOT steal or harm property or facilities, or the property of others.
- Participants are NOT allowed to possess: any weapon, alcohol, tobacco or electronics (cameras are ok)
- Prescription/over-the-counter medications (all medications are kept and dispensed by qualified BU staff). Epi-Pens, Inhalers, etc. are an exception to this rule.
- Participants will stay with the group unless otherwise directed by a Trip Leader.
- Violations of these non-negotiable rules will be dealt with decisively and may result in immediate separation or dismissal without refund of tuition.
- ***Please review these “non-negotiable” rules prior to the trip. If dismissal becomes necessary, it’s the participant’s (parents/guardians) responsibility to make arrangements for their departure from the group’s current location*
Medication: For safety, no participant is permitted to keep medications of any kind on his/her person. Epi-pens, inhalers and other emergency medications are exceptions to this. This includes prescription drugs (Rx) and over-the-counter items such as Tylenol, Sudafed, etc. All medications that are brought for the trip will be given to the qualified BU staff on the arrival day. All prescription and over-the-counter medications need to be in their original bottle(s) with the Doctor’s name, dosage, and usage instructions on the bottle. Please put all medication bottles in a clear zip-lock bag with name and instructions for administration on it. Qualified BU staff will discreetly dispense all necessary medications as instructed.
Communication: Please note that the Backcountry Unlimited office is staffed 7 days a week during the summer months. You will be able to speak with a live person 24-hours a day, 7 days a week, should you need to. The Backcountry Unlimited leaders are in contact with our office on a regular basis. These leaders have cell phones and, in certain situations, utilize satellite phones and personal locator beacons. In an effort to foster a positive sense of independence and self-reliance, we do not permit emails, phone calls or text messages to our teens during their trip. The only communication may be the occasional letter home from a student. There is no delivery to teens while they are on a Backcountry Unlimited program, so the mail delivery will be one-way. If a situation arises wherein a teen must see a physician or be treated by medical personnel of any kind, our office will notify parents/guardians as soon as possible. In these scenarios, we will make every effort to offer the opportunity for parents to speak with both their teen and their leaders.
Personal Electronics: In an effort to eliminate distractions among the group and to promote engagement in the experience, personal electronic devices, such as iPods, iPhones, iPads, handheld gaming devices, e-readers, cell phones, etc., are prohibited on all of our programs. Digital cameras and GoPros are acceptable. If your teen travels with a cell phone, it will be collected by their leaders and held until the end of the program. We do encourage teens to bring a cell phone if they are traveling alone in order to easily communicate with their parent(s)/guardian(s) and the Backcountry Unlimited office should their travel plans change. Backcountry Unlimited will not be held responsible for any electronic devices that are lost, damaged, or stolen.
Food: Backcountry Unlimited has a detailed food policy that we encourage all participants to read carefully before enrolling. We are able to accommodate most food allergies. However, there are inherent food risks that are associated with adventure travel that should be carefully considered before enrolling. If the food allergies are severe and food purchase is limited, Backcountry Unlimited may require the participant to provide additional “safe food” at their expense. Please contact Backcountry Unlimited with any questions.
I HAVE READ THIS AGREEMENT. I FULLY UNDERSTAND IT AND AGREE TO BE LEGALLY BOUND BY IT.
Mar 09-13, 2020
Pricing:
Registration Policies:
View Registration Policies
Onsite Contact Name:Adam Yarnes
Program Staff:
Immunizations Records.pdf