Forms

FORM 1

AERIAL ADVENTURES LG LLC, ASSUMPTION OF RISK
REGISTRATION FORM
FORMS 1,2 and 3 must be signed by all participants.

I am aware in signing this document for participation in the Ropes Course, Climbing Walls, Zip lines and Bungee Trampoline experience, that certain elements of the program can be physically and emotionally demanding. I understand that although the professional staff will make every reasonable effort to minimize exposure to known risks, not all dangers and hazards can be foreseen (ie: cuts, scrape, bruises, fractures, debilitating injuries, fatalities, etc.). Furthermore, I am aware that certain risks of dangers exist in these activities that are beyond the control of Aerial Adventures and its staff. I understand that Aerial Adventures LG LLC, has the right to deny participation and that it is my responsibility as a participant to follow the safety standards and guidelines, and procedures established by the staff/instructors. If I do not understand specific instructions from the staff/instructor at any time I realize it is my responsibility to ask for clarity and /or assistance.

In signing this document, I authorize the leader of the activities to secure such medical advice and services as deemed necessary for my health and safety and agree to accept financial responsibility:
-Where my health and well-being is involved
-Where medical advice has been such that further services are required
-Where all reasonable attempts to contact family have failed or where the nature of the
Emergency does not allow time to make contacts
-Where the benefits of my provincial health insurance plan have been exhausted and additional loss of income and /or medical expenses are incurred.

I understand and assume all dangers and risks associated with this course and waive all claims against Aerial Adventures LG LLC staff and assigns, it’s officers, shareholders, employees, volunteers, agents and their heirs, executors and assigns, for any incidents that should occur due to my voluntary participation in this experience. Furthermore, I give my consent to the instructors or other medical personnel to treat me in a medical situation. My signature on this document is also intended to bind my successors, heirs, representatives, administrators and assigns.

Participant’s Signature__________________________________________Date_______________

I am signing on behalf of my Child who is under the age of 18:
Parent or Guardian Signature______________________________________________

FORM 2

AERIAL ADVENTURES LG LLC
MEDICAL DISCLOSURE/HEALTH FORM

HELMET # ASSIGNED:_________

We require that this form be filled out in full.
Name:________________________________________________________________________
Address:_______________________________________________________________________
______________________________________________________________________________
Phone:________________________________________________________________________
Age:_________

In case of emergency please notify:
Name:________________________________________________________________________
Phone:________________________________________________________________________
Relationship:___________________________________________________________________
Physician Name:________________________________________________________________
Physician Phone:________________________________________________________________
Medical Policy and Number:_______________________________________________________
______________________________________________________________________________

Do you smoke? Number of packs per day______. YES_____NO______
Do you wear glasses or contacts? YES______NO______
Are you currently under a physicians care? YES_____NO_____ If yes please explain:___________________________________________________________
Are you currently taking medication? YES_____NO_____ If yes please explain:__________________________________________________________
Do you have any allergies? YES_____NO_____ If yes please expain:___________________________________________________________
Do you require special assistance of any type? YES____NO_____ If yes please explain:___________________________________________________________
Have you had a recent injury, illness, or operation? YES_____NO_____ If yes please explain:___________________________________________________________
Do you have diabetes, seizures, frequent fainting/dizziness ? YES_____NO_____ If yes please explain:___________________________________________________________
Do you have any neck, back or shoulder pain or injury? YES_____NO_____ If yes please explain:___________________________________________________________
Does your weight present health problems or limit physical activities? YES_____NO_____ If yes please explain:___________________________________________________________
Do you have a history of heart problems or high blood pressure?YES_____NO_____ If yes please explain:___________________________________________________________

If you have checked yes to #11 please note the information on the following page.

Participant’s Signature:________________________________________________Date:____________

FORM 3

Participants with a history of heart problems and/or high blood pressure are at risk while participating on the Ropes Course, Climbing Walls, Zip lines and Bungee Trampoline due to emotional and physical demands involved. Whereas heart attack and fatalities have occurred in situations where individuals with pre-existing heart/high blood pressure conditions have participated in Ropes Courses, Climbing Walls, Zip lines and Bungee Trampoline activities, AERIAL ADVENTURES LG LLC , cannot guarantee your physical safety should you choose to participate. AERIAL ADVENTURES LG LLC asks that all participants answering YES to question #11 acquire a written approval from their physician prior to participation.

For General Information Regarding Pregnancy, please note the following:

The activities involve twisting, turning, lifting, supporting body weights, unexpected physical contact, potential falling form various heights, and waist harness usage. By participating in these activities while pregnant, you will put yourself and your unborn child at risk and in potentially dangerous situations. Should you decide to participate, AERIAL ADVENTURES LG LLC asks that you attain a physician’s written approval.

I have read the AERIAL ADVENTURES LG LLC Health Forms(Forms 2 and 3) and fully understand them without question. The information I provided is accurate to the best of my knowledge.

Participant’s Signature_______________________________________________Date___________