Acknowledgment of Risk Liability Waiver and Release

Subject

Program

First Name

Last Name

Message

ACKNOWLEDGMENT OF RISK, LIABILITY WAIVER AND RELEASE
I wish to participate in the Betty J. Borry Breast Cancer Retreat (BJBBCR) program . I am aware that a BJBBCR program may involve physical risks, including but not limited to, walking on uneven ground, tripping or falling over natural and man-made objects, running, jumping, lifting and falling.

Program activities may include canoeing, kayaking, snow shoeing and participating in traditional or non-traditional field games. Each activity involves the risk of injury through trauma and possibly death. Since some activities will take place out-of-doors, there are also risks of cold or heat injury, insect or other animal bite, contact with poisonous plants and animals, injury from fallen branches, and losing balance on wet, frozen or uneven surfaces.

Every effort has been made to limit the risk involved in each activity. Throughout the program, BJBBCR staff and volunteers will update and point out specific hazards when appropriate. If at any time I am in doubt about my safety, I will not proceed further until asking for help and/or input.

In consideration of the aforementioned, I hereby agree to assume all of the risks in connection with my attendance at the BJBBCR event and to release BJBBCR from any and all liabilities and claims whatsoever arising in connection with my participation in BJBBCR activities, including travel, except onsofar as such liabilities and claims arise out  of BJBBCR’s gross negligence or willful misconduct. I certify that I am physically fit enough to take part in these activities and will consult with a health care provider for any questions I may have about my fitness to participate in an active, outdoor program. I have supplied complete and accurate medical information to BJBBCR on a separate form, and I realize that my safety may be jeopardized if I do not disclose important facts about my health. I also understand that at all times I have complete control over the level of activity I choose to take on, and no coercion to participate further will be exerted by BJBBCR staff or volunteers.

The term BJBBCR shall include the corporation named The Betty J. Borry Breast Cancer Adventure Weekend, Inc. d/b/a the Betty J. Borry Breast Cancer Retreats and its successors, trustees, officers, agents, representatives, contractors and all persons for whose conduct BJBBCR is or could be legally responsible. I agree that the laws of the State of New Hampshire shall govern this waiver and release. I affirm that I have read and understand this document.

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