Family Activities Program Form Must be completed for youth who will participate in any of our activities that is designated as a Family Activity. = Required Introduction Dear Parent, We’re so glad your child is joining our Mountaineers activity. The Mountaineers has been teaching outdoor skills to young adults for over 100 years, and we are proud to continue the tradition of incorporating youth into our courses and outings. As you know, the activity your child is enrolled in serves families. This means that the leader may adjust the pace or skill-level of the program to accommodate a variety of age groups and abilities. We also want to make sure you as a parent understand the policies and procedures we have in place to ensure your child’s safety. When youth are participating in Mountaineers programs, we ensure that at least one adult leader has gone through our youth training, making them a Qualified Youth Leader. The Qualified Youth Leader(s) working with your child strive to provide a physically and emotionally appropriate environment for your child during the activity. In Family Activities, we require that each youth is accompanied by an adult (other than the activity leader) who is designated to be responsible for that youth. What does this mean? You and your child(ren) can participate together, and you will be responsible for their supervision. You can participate with your child and their friend, as long as your child’s friend’s parents/guardians have completed the attached forms, and you will be responsible for their supervision. Your child can participate with any adult over 18, so long as that adult agrees to take responsibility for your child’s supervision, and you send your child with the attached forms. For more information, view a full copy of The Mountaineers Family Activities Handbook. Please carefully read and sign the sections below. Each of these sections is in place to protect your child and help us provide an appropriately safe program. Please don’t hesitate to contact your activity leader with any questions you have. We look forward to exploring the outdoors with your child. Sincerely, Becca Polglase Director of Education Adult Supervisors In Mountaineers Family Activities, youth must be accompanied by an adult who agrees to take responsibility for providing primary supervision of the youth. I approve the adults listed below to act as supervisors and caretakers for my child while participating in Mountaineers activities. I have informed my child(ren) that the adults listed below will act as their supervisor and caretaker while they participate in Mountaineers activities, and my child agrees to participate under the supervision of these adults. I certify that I have informed the adults listed below of their responsibilities as primary supervisors and caretakers of my child(ren) while participating in Mountaineers activities, and that they have agreed to fulfill these responsibilities. Waiver The Mountaineers ACKNOWLEDGEMENT OF RISKS AND WAIVER AND RELEASE OF LIABILITY Youth Program Participants in Family Activities PLEASE READ CAREFULLY THIS ACKNOWLEDGMENT OF RISKS, WAIVER AND RELEASE OF LIABILITY AND SIGN BELOW. The Mountaineers takes pride in our efforts to provide a safe and supervised program, but outdoor adventure programming by nature is not without risk. We do not want to diminish your enthusiasm for the experience; we want all participants to know in advance what to expect and what some of the potential risks are by participating in the program. The following describes some but not all of the risks. Slips and falls during activities can occur as a result of uneven or slippery ground, backpacking and hiking on slopes and paths with bumps, sharp sticks and exposed roots. While out of doors, participants may also be exposed to a variety of natural life including, but not limited to, marine life such as crabs, sea urchins, and jelly fish, plant life such as stinging nettles, flying insects such as yellow jackets, wasps and mosquitoes, other animals such as snakes, raccoons, goats and deer. While out of doors, participants may be exposed to hazardous conditions including but not limited to extreme heat, extreme cold, rain, snow, falling rock, exposed ledges, and steep slopes. Water activities may include swimming, wading and kayaking. All water activities have the danger of bodily harm, hypothermia and drowning. Participants may be responsible for helping with food preparation, and may be around outdoor cooking stoves, flammable materials, sharp knives and open fire. Potential consequences of the activities include, but are not limited to broken bones, muscle tears, sprains, joint problems, or other orthopedic injuries, disabling head or spinal injuries, eye injuries, heart attacks, strokes, and other cardiovascular problems, heat exhaustion or heat stroke, allergic reactions, cuts, infections, burns, dehydration, mental anguish, hypothermia, drowning or other means of death. Risks may include equipment malfunction or loss of control, collision of obstacles, variation of terrain, or unexpected actions by animals or other people. I understand that participants may act in a negligent manner that can contribute to injury to themselves or others, such as failing to maintain control, not acting within his or her abilities or not following the rules. We, youth participant and parent/guardian, understand that in Mountaineers Family Activities, each youth must be accompanied by an adult (other than the activity leader) who is designated to be responsible for that youth. Parents and their child(ren) can participate together, and parents must accept responsibility for their supervision. Adults can participate with minors who are not their children, as long as they accept responsibility for the supervision of those child(ren), and those child(ren)’s parents complete the “Adult Supervisors” form granting that authority to the supervising adult. Children can participate with any adult over 18, so long as that adult agrees to take responsibility for the child’s supervision, and the parents of the child grant supervisory authority to the adult participant, via the “Adult Supervisors” form. We, youth participant and parent/guardian, understand that it is the responsibility of each participant to participate in the whole program including activities of work, play, values and working together. We understand and support policies prohibiting participants from possessing or using tobacco products, alcoholic beverages, non prescription drugs, fireworks, knives and weapons of any kind. We recognize that participants must follow safety instructions, remain in areas designated by leaders, and refrain from behavior that is harmful to themselves or others. Failure to adhere to Mountaineers policies will be cause for participant’s dismissal from the program without refund of fees. IN CONSIDERATION FOR MY CHILD BEING PERMITTED TO PARTICIPATE IN MOUNTAINEERS ACTIVITIES, I HAVE READ OR HAVE HAD READ TO ME THE RISKS OF ACTIVITIES WITH THE MOUNTAINEERS. I VOLUNTARILY ACCEPT THE RISKS INVOLVED. I AM AWARE THAT MY CHILD WILL HAVE THE OPPORTUNITY TO PARTICIPATE IN, AND I APPROVE OF HIS/HER PARTICIPATION IN, MOUNTAINEERS ACTIVITIES INVOLVING A DEGREE OF RISK. I AGREE TO RELEASE ANY CLAIMS THAT I MIGHT HAVE AS AN ADULT FOR ANY LOSS, INJURY OR DAMAGE RELATED TO MY CHILD’S PARTICIPATION, INCLUDING CLAIMS BASED ON NEGLIGENCE. I UNDERSTAND THAT IT IS MY RESPONSIBILITY TO PROVIDE FOR MY CHILD’S ACCIDENT AND HEALTH COVERAGE WHILE PARTICIPATING IN ANY MOUNTAINEERS ACTIVITY. THE MOUNTAINEERS DOES NOT PROVIDE ANY ACCIDENT OR HEALTH COVERAGE FOR ITS PARTICIPANTS. I give permission for The Mountaineers to use, without limitation or obligation, photographs or other media that may identify or include the image or voice or me or my child to promote or interpret Mountaineers programs for any business purpose, including media coverage. I waive all claims for any compensation for such use. I understand that should a person arrive to pick up the child and appears to be under the influence of drugs or alcohol that the child will not be released until another person who is not under the influence of drugs or alcohol arrives to pick up the child. If no person is located, staff may have no recourse but to contact the police. I acknowledge that The Mountaineers or its representatives are not responsible in any way for personal clothing, items or equipment that may be lost, stolen or damaged as a result of my or my child’s participation in Mountaineers activities. I HAVE READ OR HAVE HAD READ TO ME, AND I UNDERSTAND AND AGREE TO THE ABOVE STATEMENTS. I UNDERSTAND THAT THIS FORM MAY NOT BE ALTERED AND THAT MY CHILD MAY NOT PARTICIPATE WITHOUT THIS FORM SIGNED. I ACKNOWLEDGE THAT I HAVE SIGNED THIS OF MY OWN FREE WILL, THAT THIS DOCUMENT MAY AFFECT MY LEGAL RIGHTS, AND THAT MY CHILD’S PARTICIPATION IN MOUNTAINEERS ACTIVITIES IS PURELY VOLUNTARY. Youth Participant Name Parent/Guardian Printed Name I understand that by initialing this box, I agree to the above statements in their entirety.
Family Activities Program Form Must be completed for youth who will participate in any of our activities that is designated as a Family Activity. = Required Introduction Dear Parent, We’re so glad your child is joining our Mountaineers activity. The Mountaineers has been teaching outdoor skills to young adults for over 100 years, and we are proud to continue the tradition of incorporating youth into our courses and outings. As you know, the activity your child is enrolled in serves families. This means that the leader may adjust the pace or skill-level of the program to accommodate a variety of age groups and abilities. We also want to make sure you as a parent understand the policies and procedures we have in place to ensure your child’s safety. When youth are participating in Mountaineers programs, we ensure that at least one adult leader has gone through our youth training, making them a Qualified Youth Leader. The Qualified Youth Leader(s) working with your child strive to provide a physically and emotionally appropriate environment for your child during the activity. In Family Activities, we require that each youth is accompanied by an adult (other than the activity leader) who is designated to be responsible for that youth. What does this mean? You and your child(ren) can participate together, and you will be responsible for their supervision. You can participate with your child and their friend, as long as your child’s friend’s parents/guardians have completed the attached forms, and you will be responsible for their supervision. Your child can participate with any adult over 18, so long as that adult agrees to take responsibility for your child’s supervision, and you send your child with the attached forms. For more information, view a full copy of The Mountaineers Family Activities Handbook. Please carefully read and sign the sections below. Each of these sections is in place to protect your child and help us provide an appropriately safe program. Please don’t hesitate to contact your activity leader with any questions you have. We look forward to exploring the outdoors with your child. Sincerely, Becca Polglase Director of Education Adult Supervisors In Mountaineers Family Activities, youth must be accompanied by an adult who agrees to take responsibility for providing primary supervision of the youth. I approve the adults listed below to act as supervisors and caretakers for my child while participating in Mountaineers activities. I have informed my child(ren) that the adults listed below will act as their supervisor and caretaker while they participate in Mountaineers activities, and my child agrees to participate under the supervision of these adults. I certify that I have informed the adults listed below of their responsibilities as primary supervisors and caretakers of my child(ren) while participating in Mountaineers activities, and that they have agreed to fulfill these responsibilities. Waiver The Mountaineers ACKNOWLEDGEMENT OF RISKS AND WAIVER AND RELEASE OF LIABILITY Youth Program Participants in Family Activities PLEASE READ CAREFULLY THIS ACKNOWLEDGMENT OF RISKS, WAIVER AND RELEASE OF LIABILITY AND SIGN BELOW. The Mountaineers takes pride in our efforts to provide a safe and supervised program, but outdoor adventure programming by nature is not without risk. We do not want to diminish your enthusiasm for the experience; we want all participants to know in advance what to expect and what some of the potential risks are by participating in the program. The following describes some but not all of the risks. Slips and falls during activities can occur as a result of uneven or slippery ground, backpacking and hiking on slopes and paths with bumps, sharp sticks and exposed roots. While out of doors, participants may also be exposed to a variety of natural life including, but not limited to, marine life such as crabs, sea urchins, and jelly fish, plant life such as stinging nettles, flying insects such as yellow jackets, wasps and mosquitoes, other animals such as snakes, raccoons, goats and deer. While out of doors, participants may be exposed to hazardous conditions including but not limited to extreme heat, extreme cold, rain, snow, falling rock, exposed ledges, and steep slopes. Water activities may include swimming, wading and kayaking. All water activities have the danger of bodily harm, hypothermia and drowning. Participants may be responsible for helping with food preparation, and may be around outdoor cooking stoves, flammable materials, sharp knives and open fire. Potential consequences of the activities include, but are not limited to broken bones, muscle tears, sprains, joint problems, or other orthopedic injuries, disabling head or spinal injuries, eye injuries, heart attacks, strokes, and other cardiovascular problems, heat exhaustion or heat stroke, allergic reactions, cuts, infections, burns, dehydration, mental anguish, hypothermia, drowning or other means of death. Risks may include equipment malfunction or loss of control, collision of obstacles, variation of terrain, or unexpected actions by animals or other people. I understand that participants may act in a negligent manner that can contribute to injury to themselves or others, such as failing to maintain control, not acting within his or her abilities or not following the rules. We, youth participant and parent/guardian, understand that in Mountaineers Family Activities, each youth must be accompanied by an adult (other than the activity leader) who is designated to be responsible for that youth. Parents and their child(ren) can participate together, and parents must accept responsibility for their supervision. Adults can participate with minors who are not their children, as long as they accept responsibility for the supervision of those child(ren), and those child(ren)’s parents complete the “Adult Supervisors” form granting that authority to the supervising adult. Children can participate with any adult over 18, so long as that adult agrees to take responsibility for the child’s supervision, and the parents of the child grant supervisory authority to the adult participant, via the “Adult Supervisors” form. We, youth participant and parent/guardian, understand that it is the responsibility of each participant to participate in the whole program including activities of work, play, values and working together. We understand and support policies prohibiting participants from possessing or using tobacco products, alcoholic beverages, non prescription drugs, fireworks, knives and weapons of any kind. We recognize that participants must follow safety instructions, remain in areas designated by leaders, and refrain from behavior that is harmful to themselves or others. Failure to adhere to Mountaineers policies will be cause for participant’s dismissal from the program without refund of fees. IN CONSIDERATION FOR MY CHILD BEING PERMITTED TO PARTICIPATE IN MOUNTAINEERS ACTIVITIES, I HAVE READ OR HAVE HAD READ TO ME THE RISKS OF ACTIVITIES WITH THE MOUNTAINEERS. I VOLUNTARILY ACCEPT THE RISKS INVOLVED. I AM AWARE THAT MY CHILD WILL HAVE THE OPPORTUNITY TO PARTICIPATE IN, AND I APPROVE OF HIS/HER PARTICIPATION IN, MOUNTAINEERS ACTIVITIES INVOLVING A DEGREE OF RISK. I AGREE TO RELEASE ANY CLAIMS THAT I MIGHT HAVE AS AN ADULT FOR ANY LOSS, INJURY OR DAMAGE RELATED TO MY CHILD’S PARTICIPATION, INCLUDING CLAIMS BASED ON NEGLIGENCE. I UNDERSTAND THAT IT IS MY RESPONSIBILITY TO PROVIDE FOR MY CHILD’S ACCIDENT AND HEALTH COVERAGE WHILE PARTICIPATING IN ANY MOUNTAINEERS ACTIVITY. THE MOUNTAINEERS DOES NOT PROVIDE ANY ACCIDENT OR HEALTH COVERAGE FOR ITS PARTICIPANTS. I give permission for The Mountaineers to use, without limitation or obligation, photographs or other media that may identify or include the image or voice or me or my child to promote or interpret Mountaineers programs for any business purpose, including media coverage. I waive all claims for any compensation for such use. I understand that should a person arrive to pick up the child and appears to be under the influence of drugs or alcohol that the child will not be released until another person who is not under the influence of drugs or alcohol arrives to pick up the child. If no person is located, staff may have no recourse but to contact the police. I acknowledge that The Mountaineers or its representatives are not responsible in any way for personal clothing, items or equipment that may be lost, stolen or damaged as a result of my or my child’s participation in Mountaineers activities. I HAVE READ OR HAVE HAD READ TO ME, AND I UNDERSTAND AND AGREE TO THE ABOVE STATEMENTS. I UNDERSTAND THAT THIS FORM MAY NOT BE ALTERED AND THAT MY CHILD MAY NOT PARTICIPATE WITHOUT THIS FORM SIGNED. I ACKNOWLEDGE THAT I HAVE SIGNED THIS OF MY OWN FREE WILL, THAT THIS DOCUMENT MAY AFFECT MY LEGAL RIGHTS, AND THAT MY CHILD’S PARTICIPATION IN MOUNTAINEERS ACTIVITIES IS PURELY VOLUNTARY. Youth Participant Name Parent/Guardian Printed Name I understand that by initialing this box, I agree to the above statements in their entirety.