GREAT HOLLOW WAIVER One Day High & Low Ropes


I have been informed of and understand the nature of the Great Hollow Wilderness School activities. These activities may include, but are not limited to high and low ropes courses, rock climbing, hiking, caving and cooking outdoors.
I hereby give my permission as parent or legal guardian for the below named participant to participate in all of the activities of The Regional YMCA of Western Connecticut Great Hollow Wilderness School. My permission includes an understanding and assumption of the risks, and waives any claim against The Regional YMCA of Western Connecticut Great Hollow Wilderness School and any of their staff for liability for any injuries or illness which may occur that are not the result of intentional conduct or gross negligence on their part. I also waive any claim against The Regional YMCA of Western Connecticut Great Hollow Wilderness School, and any of their staff for liability for any injuries which may occur in transporting the below named participant to and from Great Hollow Wilderness School for the purpose of visiting or participating in a course.

I understand that photographs of participants in Regional YMCA of Western Connecticut activities may be taken and used for promotion of the Regional Y in newspapers, magazines or others printed or published material. Participation in Regional Y activities includes the consent of both you and your family to be photographed and for the use of such photographs by the Regional Y UNLESS YOU NOTIFY THE REGIONAL Y IN WRITING PRIOR TO PARTICIPATION.

Print Participant’s Name___________________________________________­­­­­_____________________

_________ _______ _ Date________________________

^{Signature of Participant}

^{______________________________________________ Date______________________}

^{Signature of Parent or Guardian (if participant under age 18)}

Rev. 05/05