Chapter /
Activity:
____________________________________________________________________________________________________________
Leader(s):
_______________________________________________________________________
Trip Date(s):________________________________
ACKNOWLEDGMENT OF RISKS, ASSUMPTION OF
RISKS, AND RELEASE AGREEMENT FOR AMC
VOLUNTEER-LED ACTIVITIES
PLEASE
READ THIS ENTIRE DOCUMENT CAREFULLY BEFORE SIGNING.
In consideration of the services of the Appalachian Mountain Club, Inc., a
charitable, not-for-profit corporation, organized and existing under the laws
of Massachusetts, and its chapters, including all officers, employees,
representatives, volunteers (including leaders and co-leaders), members and all
other persons or entities associated with it (collectively referred to in this
Document as
'AMC'),
I acknowledge and agree as follows:
AMC
volunteer-led educational and/or recreational activities
may
include, but are not limited to hiking, backpacking, camping, biking, skiing,
maintenance of trails and facilities, mountaineering, rock and ice climbing,
canoeing, kayaking, sailing, use of AMC
huts or other facilities and transportation or travel to and from activities
(referred to in this Document as
'activities'
or
'these
activities').
The leaders of these activities are
volunteers. They are not paid professional guides or leaders. In all
activities, all participants share in the responsibility for their own safety
and the safety of the group.
I take responsibility
for having appropriate skills, physical conditioning, equipment and supplies
for these activities.
These
activities include inherent and other risks, hazards and dangers that can cause
or lead to injury, property damage, illness, mental or emotional trauma,
paralysis, disability or death to participant or others.
Some,
but not all of these risks, hazards and dangers include: hazardous and
unpredictable ground, water or weather conditions; misjudgments made by
leaders, co-leaders, participants or others; travel in remote areas that can
cause delays in transportation, evacuation and medical care; equipment that can
fail or malfunction; the potential that the participant or others (e.g.
co-participant, driver, medical and rescue personnel) may act carelessly or
recklessly. I understand that AMC
staff, leaders or other personnel cannot assure participant’s safety or
eliminate these risks.
I am voluntarily
participating with knowledge of the risks. Therefore, I assume and accept full
responsibility for the inherent and other risks of these activities (both known
and unknown), and for any injury, damage, death or other loss suffered by me,
resulting from those risks.
I
agree to release and not to sue AMC
(as
AMC
is defined above) in regard to all claims, liabilities, suits, or expenses
(hereafter collectively ‘claim’ or
'claims'),
including claims caused or alleged to be caused by the negligence of AMC (but
not its gross negligence or intentional or reckless misconduct),
for
any injury, damage, death or other loss to me in any way connected with my
participation in these activities, or my use of AMC
equipment or facilities.
I understand I agree
here to waive all claims I may have against AMC,
and
agree that neither I, nor anyone acting on my behalf, will make a claim or file
a lawsuit against AMC.
I agree
that
the substantive laws of
Massachusetts
govern this Document and all other aspects of my relationship with AMC,
and that any mediation, suit, or other proceeding must be filed or entered into
only in
Massachusetts.
Any portion of this Document deemed
unlawful or unenforceable shall not affect the remaining provisions, and those
remaining provisions shall continue in full force and effect.
I HAVE CAREFULLY READ, UNDERSTAND AND
VOLUNTARILY SIGN THIS DOCUMENT AND ACKNOWLEDGE THAT IT SHALL BE EFFECTIVE AND
BINDING UPON ME, MY MINOR CHILDREN AND OTHER FAMILY MEMBERS, AND MY HEIRS,
EXECUTORS, REPRESENTATIVES AND ESTATE.
Name Signature Date
Emergency Contact Phone #
1.____________________________________________________________________________________________________________________________________
2.____________________________________________________________________________________________________________________________________
3.____________________________________________________________________________________________________________________________________
4.____________________________________________________________________________________________________________________________________
5.____________________________________________________________________________________________________________________________________
6.____________________________________________________________________________________________________________________________________
7.____________________________________________________________________________________________________________________________________
8.____________________________________________________________________________________________________________________________________
9.____________________________________________________________________________________________________________________________________
10.___________________________________________________________________________________________________________________________________
Please
return this form to your committee or chapter representative when your activity
is complete or mail to:
AMC
Volunteer Release Agreement, 5 Joy
St.,
Boston, MA 02108 OLDC
2/2/02