ADIRONDACK MOUNTAIN CLUB, INC.
PO Box 867, Lake Placid, New York 12946
Before you arrive, thoroughly read all program materials, and call us if you have any questions. The Acknowledgment of Risk statement, Release of Liability, Photo Release sections of this form must be completed and signed before you can attend the program.
Safety is a fundamental part of the Adirondack Mountain Club (ADK) operation. Safety is taught and practiced on every program offered by the ADK. Despite operating to the best of our capabilities, the possibility of an accident still exists. We cannot - nor can anyone - reduce that possibility to zero.
ACKNOWLEDGMENT OF RISK
In consideration of the services of the Adirondack Mountain Club, their employees, members, trip leaders, chapters, groups, representatives or agents and all other persons or entities acting in any capacity on their behalf (collectively referred to as ADK), I agree as follows:
I acknowledge that this program entails known and unanticipated risks, which cannot be eliminated without destroying the unique character of this activity. The same elements that contribute to the unique character of this activity can be causes of loss or damage to my equipment, accidental injury, illness, or in extreme cases, permanent trauma, disability, or death.
I understand that ADK does not want to frighten me or reduce my enthusiasm for this activity, but thinks it is important for me to know in advance what to expect and to be informed of the activities' inherent risks. The following describes some, but not all, of those risks:
ADK programs camp and travel out of doors, where they are subject to numerous risks, environmental and otherwise. Activities vary from program to program, and include hiking and backpacking, rock climbing, mountaineering, whitewater and flat water canoeing and kayaking, skiing, snowshoeing, fishing, and trail work. In the backcountry, meals are prepared over gas stoves and water requires disinfection before use. Camping risks and hazards includes burns, cuts, diarrhea and flu-like illness. ADK programs occur in remote places, many hours from medical facilities. Communication and transportation can be difficult and sometimes evacuations and medical care may be delayed. Travel is by vehicle, canoe, kayak, skis, on foot and by other means, over rugged unpredictable terrain, including stream crossings, snow and ice, steep slopes, slippery rocks, and downed timber. Environmental risks and hazards include rapidly moving, deep, or cold water, insects, falling or rolling rock, lightening, avalanches, floods, and unpredictable forces of nature, including weather which may change to extreme conditions without notice. Possible injuries and illnesses include hypothermia, frostbite, sunburn, heatstroke, dehydration, and other mild or serious conditions. Decisions are made by the instructor(s) and participants in a wilderness setting, based on a variety of perceptions and evaluations which by their nature are imprecise and subject to errors in judgment. Throughout the course, participants are responsible for their own safety and for the safety of other members of their course.
I am aware that ADK programs include risks of injury or death to myself. I understand the description above of these risks is not complete and that other unknown or unanticipated risks may result in property loss, injury, or death. I expressly agree and promise to accept and assume all the inherent risks identified herein and those inherent risks not specifically identified. My participation in this activity is purely voluntary, no one is forcing me to participate, and I elect to participate in spite of and with full knowledge of the inherent risks. I agree to be solely responsible for my own safety and to take every precaution to provide for my own safety and well-being.
I have read, understood, and accepted the terms and conditions stated herein and acknowledge that this agreement
shall be effective and binding upon myself, my heirs, assigns, personal representatives and estate and all members of my family. With full knowledge of these dangers, I hereby agree for myself, all of my family members and heirs to RELEASE ADK and any of its employees, members, trip leaders, chapters, officers, directors, governors, or agents liability claims demands or any causes of action and agree NOT TO MAKE ANY CLAIM against ADK or any of its chapters, representatives or agents whatsoever which may arise during my participation in the program stated above.
RELEASE OF LIABILITY
I intend this RELEASE OF LIABILITY to be effective whether or not any loss, damage, injury or death results, in whole or in part, from the negligence of the ADK, or any of its agents, employees, officers, instructors, guides, directors, governors, trip leaders and/or members. I understand that negligence means a failure to do an act which a reasonable and careful person would do, or the doing of an act which a reasonable and careful person would not do, under the same circumstances, to protect himself, herself or others from injury or death.
I assume full responsibility for my personal injuries, including injuries resulting in death, which might occur as the result of my own negligence and/or the negligence of lack of care of ADK, its employees, members, chapters, trip leaders, groups, representatives or agents. I agree to be solely responsible for my own safety and to take every precaution to provide for my own safety and well-being while participating in this program.
I hereby give to and grant to the Adirondack Mountain Club, Inc., the unrestricted right and permission to use and publish any and all photographs and/or videos which its employees, assignees, licensee, or representatives may have taken of me for any purpose whatsoever, including (but not limited to) illustration, program promotion, publicity, and advertising.
I hereby release the Adirondack Mountain Club, Inc. from any and all claims and causes of action arising out of use of said photographs and/or videos of me, including any and all claims for libel.
By clicking YES and typing my name below, I am stating that I am over the age of eighteen and I have read the foregoing ACKNOWLEDGMENT OF RISK, RELEASE OF LIABILITY, & PHOTO RELEASE and state that I fully understand the meaning of them. I have read, understood, and accepted the terms and conditions stated herein and acknowledge that this agreement shall be effective and binding upon me, my heirs, assigns, personal representatives and estate and all members of my family.
Name: (first & last)
IF UNDER 18 YEARS OF AGE, PARENT OR GUARDIAN MUST READ AND SIGN ELECTRONICALLY BELOW:
**MUST ELECTRONICALLY SIGN BEFORE PARTICIPATING IN PROGRAM**
**MUST ELECTRONICALLY SIGN BEFORE PARTICIPATING IN PROGRAM.** By clicking YES below, I hereby acknowledge that I am the legal guardian of the above minor and have read the above and I hereby consent to the terms of the ACKNOWLEDGMENT OF RISK, RELEASE OF LIABILITY, and PHOTO RELEASE on behalf of the named minor, and give my consent to the participation of the above named minor in all activities of ADK on the terms stated.
Name of Parent or Guardian: (first & last)
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