I understand that I will be
participating in a two-day bear-viewing eco-hike in the Northern Japanese
Alps. I have read a description
of the program and the organizers
have been available to answer my questions.
I acknowledge this hiking program
involves known and inherent risks, as well as unknown/unanticipated risks. Inherent risks may include those
ordinarily associated with moderate to vigorous physical activity in high
altitude or wilderness terrain. The program will take us to semi-remote areas
where communication may be difficult and medical care significantly delayed.
Travel will be by automobile (private or taxi), and on foot, over rugged,
mountainous terrain. Activities will include hiking and backpacking. I
understand that travel and outdoor activities will be subject to unpredictable
forces of nature including but not limited to extreme weather, falling rocks,
lightning, earthquakes, insects, snakes and Asiatic black bears. Participants
may be exposed to animals who may cause serious harm and whose behavior cannot
be predicted; equipment may fail or malfunction despite reasonable maintenance;
and errors of judgment or negligence may occur, by myself, co-participants or
by the organizers. The preceding risks, hazards and dangers may result in a
variety of illnesses and injuries including, but not limited to high altitude
illnesses, heat stroke, dehydration and suffering sprains, fractures, and other
trauma including sickness, mental distress, disability or even death.
I expressly agree and promise to
accept and assume all of the risks existing in the two-day bear viewing
eco-hike I am participating in, including but not limited to those listed above. My participation in this activity
is purely voluntary, and I elect to participate in spite of the risks. I also
hereby voluntarily release, forever discharge and agree to indemnify and hold
harmless the organizers and independent contractors (Òreleased partiesÓ) from
any and all claims, demands or causes of action that are in any way connected
with my participation in this activity, including all such claims that allege
negligent acts or omissions. I HEREBY AGREE TO INDEMNIFY THE ORGANIZERS AND ALL
RELEASED PARTIES FROM ANY CLAIM MADE BY ME OR MY HEIRS OR SURVIVORS ON ACCOUNT
OF ANY INJURY OR LOSS THAT I MAY SUFFER ARISING IN ANY WAY OUT OF THE
PROGRAM. I FURTHER INDEMNIFY THE
ORGANIZERS AND ALL RELEASED PARTIES FROM A CLAIM THAT MIGHT BE BROUGHT BY A
CO-PARTICIPANT ARISING IN ANY WAY FROM MY CONDUCT.
The following provisions apply to all
participants:
1)
I
am in general good health and am able to participate in an at least 6 km uphill
hike carrying my own backpack. I
have no medical or physical condition which could interfere with my
participation in the program or interfere with my health or safety or the
safety of any other participant.
2)
I
certify that I have insurance to cover any injury or damage I may cause or
suffer while participating, or else I agree to bear the costs of such injury or
damage, including the cost of any evacuation and medical care.
3)
I
authorize and consent to the organizers taking photographs and video film of my
participation in this program, and to the unrestricted use and publication of such
photos or videos to promote their activities.
4)
I agree
that in the event any portion of this agreement is deemed invalid or
unenforceable, all other portions of this agreement shall remain in full force
and effect.
BY SIGNING THIS DOCUMENT, I ACKNOWLEDGE
THAT I HAVE HAD SUFFICIENT OPPORTUNITY TO READ THIS ENTIRE DOCUMENT. I HAVE
READ AND UNDERSTOOD IT, AND I AGREE TO BE BOUND BY ITS TERMS.
Participant Signature Print
Name _______ ____
ParticipantÕs Age _____ or
___ (check if 18 years or over as of start date of program) Date
___________