Section 1 of 20
Participant Form for Outside Perspectives Adult Expeditions
This form includes Participant Information, Medical History, Consent, Waiver, Release and Acknowledgement for a multi-day course or expedition with Outside Perspectives. This form is good for any course or expedition with Outside Perspectives within a year of its completion. This form does not contain a medication section.
Please enter your email address (the person who is completing this form) to get started.
Please enter your email address (the person who is completing this form) to get started.
Email
This form is collecting emails.Change settings
If the answer is not pre-filled below, indicate the participating organization. If unsure, refer to the email received with this form link.
If the answer is not pre-filled below, indicate the participating organization. If unsure, refer to the email received with this form link.
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Answer key
(0 points)
Loading...
Section 2 of 20
Have you filled out a paper version of this form?
Did you already fill out a paper copy of this form?
Did you already fill out a paper copy of this form?
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
YES
Continue to next section
NO
Continue to next section
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Section 3 of 20
Please Email the Paper Version to Outside Perspectives
You can scan the document or take a picture of the document (please make sure the text is readable!), and email it to info@outsideperspectives.org.
I have emailed the document (and all associated forms) to Outside Perspectives.
I have emailed the document (and all associated forms) to Outside Perspectives.
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Yes
Continue to next section
No
Continue to next section
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Section 4 of 20
Participant Information
Name:
Name:
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Answer key
(0 points)
Loading...
Date of birth:
Date of birth:
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Answer key
(0 points)
Loading...
Age:
Age:
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Answer key
(0 points)
Loading...
Gender
Gender
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Male
Continue to next section
Female
Continue to next section
Transgender
Continue to next section
Intersex
Continue to next section
Other…
Add option
…
Answer key
(0 points)
Loading...
Section 5 of 20
Gender Continued
Outside Perspectives strives to be a safe zone or a safe space where all people can bring their authentic selves and feel safe, welcome and included. Please help us make you feel comfortable by letting us know the following information.
What gender do you identify as?
What gender do you identify as?
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Answer key
(0 points)
Loading...
What pronouns do you prefer?
What pronouns do you prefer?
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Answer key
(0 points)
Loading...
Section 6 of 20
Participant Information Continued
Race (eg. African-American, Asian, Caucasian, Latinx, Native American, etc):
Race (eg. African-American, Asian, Caucasian, Latinx, Native American, etc):
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Answer key
(0 points)
Loading...
Ethnicity (eg. Costa Rican, Hawaiian, Irish, etc):
Ethnicity (eg. Costa Rican, Hawaiian, Irish, etc):
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Answer key
(0 points)
Loading...
Is English the participant's second language?
Is English the participant's second language?
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Yes
Continue to next section
No
Continue to next section
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Section 7 of 20
Translation support
Is translation support necessary?
Is translation support necessary?
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Yes
No
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Section 8 of 20
Participant Information continued
Your home address:
Your home address:
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Answer key
(0 points)
Loading...
Yout primary telephone:
Yout primary telephone:
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Answer key
(0 points)
Loading...
Your alternate telephone:
Your alternate telephone:
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Answer key
(0 points)
Loading...
Section 9 of 20
Emergency contact
Name of person to be notified in case of an emergency
Name of person to be notified in case of an emergency
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Answer key
(0 points)
Loading...
Relation to you
Relation to you
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Answer key
(0 points)
Loading...
Telephone or cell phone of emergency contact
Telephone or cell phone of emergency contact
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Answer key
(0 points)
Loading...
Section 10 of 20
Pertinent expedition information and consent
Outside Perspectives conducts physically demanding courses. There are certain risks to be assumed when participating in activities of a physical nature and the participant may risk personal injury. Outside Perspectives instructors and staff will inform the group of specific safety protocols and will coach participants before each activity. While the expedition can be challenging, it is expected that any person with typical physical and mental abilities can complete the program successfully.
Expedition participants take part in backcountry expeditions that include camping and hiking. You will be sleeping under tarps or in tents (not cabins), and inside of sleeping bags for the entire course unless specified differently by group organizers. You may carry thirty to fifty pound backpacks for an extended period of time, while you are hiking. During the expedition, the group will hike for an average of five miles per day. Expeditions occur in remote areas and in all types of weather including wind, rain, cold, heat and electrical storms. While many precautions are taken to avoid contact with animals, insects and bacteria, environmental hazards include - but are not limited to - potential exposure to diseases such as tick or mosquito-borne illnesses (i.e. Lyme Disease) and Giardia.
Due to the physical nature of the activities and the remote locations, it is very important that you inform Outside Perspectives of any and all relevant physical and mental health information, including medications and dietary needs, by filling out the required medical sections of this form. Omitting this information may affect your safety and the safety of others. Outside Perspectives will not exclude a you from an expedition for a health or medical reason unless participation provides an unmanageable risk or burden to instructors, you, or to the group, as determined by Outside Perspectives. Removing barriers to the outdoors is part of the organization's mission.
Outside Perspectives provides ample and nutritious meals prepared by the expedition participants and instructors. All drinking water from natural sources are purified by approved methods such as boiling, filtration, or by chemical (i.e. iodine) treatment prior to consumption. Personal hygiene and self-care methods are limited in a wilderness setting and include cold water clean up unless specified as different. Toilet facilities are latrines and outhouses unless specified as different.
Participants are prohibited from using alcohol and recreational drugs while on course. If you smoke it is an expectation that you remove yourself from the group to do so and you are encouraged to use nicotine patches or gum are while on the expedition instead of cigarettes. Outside Perspectives is a Leave No Trace (LNT) program and it is expected that all participants will carry out all personal trash with them and nothing will be left behind even if it biodegrades. This includes apple cores, orange peels, wet wipes, and cigarette butts. The exception to this is toilet paper if it is properly buried.
Due to the distractions they cause, course goals, and the risk of damage to devices, electronics are not recommended on expeditions; this includes cell phones. Expeditions are an opportunity to unplug and detach. Outside Perspectives encourages participants to challenge themselves to take advantage of this opportunity and find out the many benefits time away from screens can have. There is an expectation that phones will be turned off throughout the course and not be used at during activities, group time or reflective time. Please communicate with instructors about exceptions that may be needed while on course. Outside Perspectives' staff will carry cell phones for emergencies or other unforeseen circumstances that require communication.
Outside Perspectives is a challenge by choice program, which means participants ultimately have the freewill to decide to participate in the program and any activity that may be presented. However, once you have committed to the expedition, you will be strongly encouraged to finish unless there are unforeseen or unexpected circumstances.
Expedition participants take part in backcountry expeditions that include camping and hiking. You will be sleeping under tarps or in tents (not cabins), and inside of sleeping bags for the entire course unless specified differently by group organizers. You may carry thirty to fifty pound backpacks for an extended period of time, while you are hiking. During the expedition, the group will hike for an average of five miles per day. Expeditions occur in remote areas and in all types of weather including wind, rain, cold, heat and electrical storms. While many precautions are taken to avoid contact with animals, insects and bacteria, environmental hazards include - but are not limited to - potential exposure to diseases such as tick or mosquito-borne illnesses (i.e. Lyme Disease) and Giardia.
Due to the physical nature of the activities and the remote locations, it is very important that you inform Outside Perspectives of any and all relevant physical and mental health information, including medications and dietary needs, by filling out the required medical sections of this form. Omitting this information may affect your safety and the safety of others. Outside Perspectives will not exclude a you from an expedition for a health or medical reason unless participation provides an unmanageable risk or burden to instructors, you, or to the group, as determined by Outside Perspectives. Removing barriers to the outdoors is part of the organization's mission.
Outside Perspectives provides ample and nutritious meals prepared by the expedition participants and instructors. All drinking water from natural sources are purified by approved methods such as boiling, filtration, or by chemical (i.e. iodine) treatment prior to consumption. Personal hygiene and self-care methods are limited in a wilderness setting and include cold water clean up unless specified as different. Toilet facilities are latrines and outhouses unless specified as different.
Participants are prohibited from using alcohol and recreational drugs while on course. If you smoke it is an expectation that you remove yourself from the group to do so and you are encouraged to use nicotine patches or gum are while on the expedition instead of cigarettes. Outside Perspectives is a Leave No Trace (LNT) program and it is expected that all participants will carry out all personal trash with them and nothing will be left behind even if it biodegrades. This includes apple cores, orange peels, wet wipes, and cigarette butts. The exception to this is toilet paper if it is properly buried.
Due to the distractions they cause, course goals, and the risk of damage to devices, electronics are not recommended on expeditions; this includes cell phones. Expeditions are an opportunity to unplug and detach. Outside Perspectives encourages participants to challenge themselves to take advantage of this opportunity and find out the many benefits time away from screens can have. There is an expectation that phones will be turned off throughout the course and not be used at during activities, group time or reflective time. Please communicate with instructors about exceptions that may be needed while on course. Outside Perspectives' staff will carry cell phones for emergencies or other unforeseen circumstances that require communication.
Outside Perspectives is a challenge by choice program, which means participants ultimately have the freewill to decide to participate in the program and any activity that may be presented. However, once you have committed to the expedition, you will be strongly encouraged to finish unless there are unforeseen or unexpected circumstances.
I have read and understand the information above including that course may be physically challenging, take place in a remote setting, and be primitive in nature. I also understand the expectations around electronics. With these understandings I willingly agree to attend this expedition with Outside Perspectives Inc.
I have read and understand the information above including that course may be physically challenging, take place in a remote setting, and be primitive in nature. I also understand the expectations around electronics. With these understandings I willingly agree to attend this expedition with Outside Perspectives Inc.
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
YES
NO
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Section 11 of 20
Waiver
In consideration of the risk of injury while participating in hiking, backpacking and other outdoor activities (“activities”), and as consideration for the right to participate in the activities, I hereby, for myself, my heirs, executors, administrators, assigns, or personal representatives, knowingly and voluntarily enter into the waiver and release of liability and hereby waive any and all rights, claims or causes of action of any kind whatsoever arising out of my participation in the activities, and do hereby release and forever discharge Outside Perspectives, Inc. located at 199 Wheeler Rd., Litchfield, Connecticut 06759, their affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and assigns, for any physical or psychological injury, including but not limited to illness, paralysis, death, damages, economical or emotional loss that I or the minor I represent may suffer as a direct result of my participation in the aforementioned activities, including traveling to and from an event related to these activities.
In consideration of the risk of injury while participating in hiking, backpacking and other outdoor activities (“activities”), and as consideration for the right to participate in the activities, I hereby, for myself, my heirs, executors, administrators, assigns, or personal representatives, knowingly and voluntarily enter into the waiver and release of liability and hereby waive any and all rights, claims or causes of action of any kind whatsoever arising out of my participation in the activities, and do hereby release and forever discharge Outside Perspectives, Inc. located at 199 Wheeler Rd., Litchfield, Connecticut 06759, their affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and assigns, for any physical or psychological injury, including but not limited to illness, paralysis, death, damages, economical or emotional loss that I or the minor I represent may suffer as a direct result of my participation in the aforementioned activities, including traveling to and from an event related to these activities.
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
YES
NO
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
I am voluntarily participating in the aforementioned activity and I am participating in the activities entirely at my own risk. I am aware of the risks associated with traveling to and from as well as participating in this activity, which may include, but are not limited to, physical or psychological injury, pain, suffering, illness, disfigurement, temporary or permanent disability (including paralysis), economic or emotional loss, and death. I understand that these injuries or outcomes may arise from my own or others’ negligence, conditions related to travel, or the condition of the activity location(s). Nonetheless I assume all related risks, both known or unknown to me, of participating in this activity, including travel to, from and during this activity.
I am voluntarily participating in the aforementioned activity and I am participating in the activities entirely at my own risk. I am aware of the risks associated with traveling to and from as well as participating in this activity, which may include, but are not limited to, physical or psychological injury, pain, suffering, illness, disfigurement, temporary or permanent disability (including paralysis), economic or emotional loss, and death. I understand that these injuries or outcomes may arise from my own or others’ negligence, conditions related to travel, or the condition of the activity location(s). Nonetheless I assume all related risks, both known or unknown to me, of participating in this activity, including travel to, from and during this activity.
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
YES
NO
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
I agree to indemnify and hold harmless Outside Perspectives Inc. against any and all claims, suits or actions of any kind whatsoever for liability, damages, compensation or otherwise brought by me or anyone on my behalf, including attorney’s fees and any related costs, if litigation arises pursuant to any claims made by me or by anyone else acting on my behalf.
I agree to indemnify and hold harmless Outside Perspectives Inc. against any and all claims, suits or actions of any kind whatsoever for liability, damages, compensation or otherwise brought by me or anyone on my behalf, including attorney’s fees and any related costs, if litigation arises pursuant to any claims made by me or by anyone else acting on my behalf.
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
YES
NO
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Section 12 of 20
Medical Insurance Information and Consent
If yes, please be sure to bring your insurance card on the expedition with you.
Are you covered by a hospitalization and medical care insurance policy?
Are you covered by a hospitalization and medical care insurance policy?
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
YES
Continue to next section
NO
Continue to next section
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Section 13 of 20
Consent for Non-Insured.
I will assume full responsibility for any medical costs incurred while I am with Outside Perspectives.
I will assume full responsibility for any medical costs incurred while I am with Outside Perspectives.
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
YES
NO
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Section 14 of 20
Medical History Information
INSTRUCTIONS: Please be thorough by alerting us to any of the following conditions that you have had in the past or may now be experiencing, then give details in the space provided. Due to the physical nature of the activities and the remote locations, it is very important that you inform Outside Perspectives of any and all relevant physical and mental health information, including medications and dietary needs.
PLEASE NOTE: Omitting this information may affect your safety and the safety of others. Outside Perspectives will not exclude a you from an expedition for a health or medical reason unless participation provides an unmanageable risk or burden to instructors, you, or to the group, as determined by Outside Perspectives. Removing barriers to the outdoors is part of the organization's mission.
PLEASE NOTE: Omitting this information may affect your safety and the safety of others. Outside Perspectives will not exclude a you from an expedition for a health or medical reason unless participation provides an unmanageable risk or burden to instructors, you, or to the group, as determined by Outside Perspectives. Removing barriers to the outdoors is part of the organization's mission.
Have you ever had, or do you currently have, Asthma?
Have you ever had, or do you currently have, Asthma?
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
PLEASE NOTE: If you have a current diagnoses of Asthma you are required to bring all prescribed inhalers as well as one unused back-up inhaler for each prescription.
Yes
Yes, but not currently
No
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Do you smoke?
Do you smoke?
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
PLEASE NOTE: If you smoke it is an expectation that you remove yourself from the group to do so and you are encouraged to use nicotine patches or gum are while on expedition.
Yes
No
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Does you have any special dietary restrictions due to health, allergies or religious beliefs?
Does you have any special dietary restrictions due to health, allergies or religious beliefs?
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Yes
No
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
If yes, please list what is required in detail below.
If yes, please list what is required in detail below.
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Answer key
(0 points)
Loading...
Does you have any known food, drug or environmental allergies?
Does you have any known food, drug or environmental allergies?
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Yes
No
Maybe
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
If yes, please give details, triggers, date of last reaction, severity of last reaction, any treatment given and if there is a risk for anaphylaxis (difficulty breathing). If no, please enter "n/a".
If yes, please give details, triggers, date of last reaction, severity of last reaction, any treatment given and if there is a risk for anaphylaxis (difficulty breathing). If no, please enter "n/a".
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Answer key
(0 points)
Loading...
Does you have a prescription for Epinephrine (Epi-Pen)?
Does you have a prescription for Epinephrine (Epi-Pen)?
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Yes
No
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Will you bring an Epi-Pen with you on the expedition?
Will you bring an Epi-Pen with you on the expedition?
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Yes
No
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Please check for all relevant medical conditions or concerns you have:
Please check for all relevant medical conditions or concerns you have:
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Vision problems: glasses or contact lenses
Hearing problems: hearing aids
Palpitation of the heart, irregular heart beat, heart murmurs
Chronic cough, Bronchitis, bloody sputum, Pneumonia
Recent illness, injury or surgery
Any severe injury to head, chest, internal organs
Jaundice, Hepatitis, TB, Meningitis or Encephalitis
Dizzy spells, fainting, convulsions, persistent headaches
Seizure disorder, Epilepsy
Broken bones, joint dislocations, serious sprains
Problems with knees or feet
Problems with back
Reaction to extremes of temperature: frostbite, heat exhaustion
Hernia
Frequent diarrhea or constipation, abdominal cramps or severe menstrual cramps
Allergies -- medicine, food, insect bites and/or other substances
Diabetes
NONE OF THE ABOVE
Other…
Add option
…
Answer key
(0 points)
Loading...
Please elaborate upon any of the checked medical/health conditions or concerns listed above. If you have none please enter "n/a."
Please elaborate upon any of the checked medical/health conditions or concerns listed above. If you have none please enter "n/a."
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Answer key
(0 points)
Loading...
Do you take any medications?
Do you take any medications?
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Yes
Continue to next section
No
Continue to next section
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Section 15 of 20
Medication Details
Please list any possible side effects of your medication(s).
Please list any possible side effects of your medication(s).
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Answer key
(0 points)
Loading...
Section 16 of 20
Participant Photo Release
Permission is granted for Outside Perspectives to take photographic images of you and to create digital documentation of the course. Images will be shared with all participants of the expedition, as well as, the program partnership agency.
Permission is granted for Outside Perspectives to take photographic images of you and to create digital documentation of the course. Images will be shared with all participants of the expedition, as well as, the program partnership agency.
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
YES
NO
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Permission is granted to Outside Perspectives to use photographic and video images of you taken on expeditions in all aspects of business including slide shows, orientations, and public information materials, such as newsletters, websites, brochures/pamphlets and newspaper or journal articles.
Permission is granted to Outside Perspectives to use photographic and video images of you taken on expeditions in all aspects of business including slide shows, orientations, and public information materials, such as newsletters, websites, brochures/pamphlets and newspaper or journal articles.
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
YES
Continue to next section
NO
Continue to next section
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Section 17 of 20
Photo Permissions
Please specify if there are things photos of you CAN be used for.
Please specify if there are things photos of you CAN be used for.
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Slide show presentations generally shown to other programs, potential participants and their families.
Printed public information materials, such as brochures/pamphlets.
Online public information materials such as newsletters, websites, and social media.
Newspaper or journal articles.
To distribute DIGITAL copies of photos participant is in to other group members. (ie. group photo.)
To distribute PHYSICAL copies of photos participant is in to other group members. (ie. group photo.)
CAN'T BE USED FOR ANYTHING.
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Section 18 of 20
Permission for Names in Photos
In any images available to the public, permission is granted to Outside Perspectives to identify you by...
In any images available to the public, permission is granted to Outside Perspectives to identify you by...
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
First and last name
First name only
CAN NOT identify me
Tag me in social media (if I follow Outside Perspectives)
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Section 19 of 20
Acknowledgement
I acknowledge that I have carefully read this "Consent, Waiver, Release & Disclosure Form" and FULLY UNDERSTAND WHAT THE EXPEDITION ENTAILS. I acknowledge that by signing this document (my electronic signature) I am voluntarily giving consent for myself to participate. Further, I acknowledge that my signature IS A RELEASE OF LIABILITY and expressly agree to release and discharge Outside Perspectives, Inc. and all of its affiliates managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and assigns, from any and all claims or causes of action and I agree to voluntarily give up or waive any right that I otherwise have to bring a legal action against Outside Perspectives for personal injury or property damage.
Please read above and check:
Please read above and check:
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
YES
NO
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Section 20 of 20
Participant signature
By typing your name in the fields below you are confirming that the above information is true to the best of your knowledge, you understand the risks involved in the expedition, and that you can participate in the expedition. Once signed and submitted, this form good for any Course with Outside Perspectives within a year of its completion.
Name of participant for electronic signature
Name of participant for electronic signature
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Answer key
(0 points)
Loading...
Link to Sheets
Message for respondents
This form is no longer accepting responses
Summary
Question
Individual
Insights
Total points distribution
Loading...
Settings
Responses
Manage how responses are collected and protected
Presentation
Manage how the form and responses are presented
Defaults
Form defaults
Settings applied to this form and new forms
Question defaults
Settings applied to all new questions