WLI

WFR - 5-Day - WLI Participant Agreement - Parent/Guardian


WILDERNESS LEADERSHIP INSTITUTE, LLC
PARTICIPANT AGREEMENT

Coronavirus/COVID-19 Risk Notice, Personal Responsibility &
Conditions of Participation, and Consent to Treat &
Full Disclosure Statement

Coronavirus/COVID-19 Risk Notice

An inherent risk of exposure to coronavirus/COVID-19 exists in every public place or where people are present. COVID-19 is an extremely contagious disease that can lead to serious illness and death. COVID-19 is a new disease and there is limited information regarding risk factors for severe illness. According to the Centers for Disease Control and Prevention, older adults and people of any age with serious underlying medical conditions are at higher risk for severe illness.

WLI has taken enhanced cleaning and distancing measures in an effort to mitigate the risks to you, our other participants, and staff, but we cannot ensure your safety.

By participating in the Programs (“Program” is defined as any course, exam, program, activity, clinic, workshop, instruction, assessment, or guided venture offered by WLI), Participant voluntarily assumes all risks related to exposure to coronavirus/COVID-19. Certain Programs, such as medical training, may carry additional risk of transmission due to the close personal contact which is an integral part of those Programs. If you do not wish to encounter that risk, please do not participate.

Personal Responsibility and Conditions of Participation

Participant attests that they have no physical or mental condition that makes it inadvisable to participate in the Wilderness Leadership Institute (“WLI”) Programs, and that they are not participating against medical advice. Participant attests that, to their knowledge, they have not had symptoms of, or been exposed to anyone with, coronavirus/COVID-19 within 14 days prior to participation. Participant understands that if their medical condition changes, it is their sole responsibility to immediately inform WLI staff of such change and cease participation immediately.

Participant understands and acknowledges that WLI is not making any determination of their fitness for any Program; rather, Participant represents to WLI that they are physically fit and ready to participate. If in doubt, Participant should consult with their personal physician. Failure to disclose any requested medical information may result in serious harm to Participant and others.

WLI recommends that all participants wear helmets for certain Programs. If Participant chooses not to wear a helmet, they do so at their own risk, and accept full responsibility for any injuries.

Participant understands and acknowledges that their participation in WLI Programs is voluntary.

Participant understands and acknowledges that they have the opportunity to inspect equipment and location(s) prior to participating.

Participant understands and acknowledges that they are obligated to follow the rules of the Programs, use common sense, use good judgment, and be aware of their surroundings.

If Participant observes any unusual hazard that they believe may jeopardize the safety of Participant or others, they will immediately inform WLI staff of the potential hazard and cease participation until the issue is addressed.

If Participant is a minor, by signing this Participant Agreement the minor’s parent or legal guardian agrees to explain the risks and importance of exercising common sense and good judgment to the Participant.

Consent to Treat and Full Disclosure Statement

Participant represents and warrants that they have accurately provided to WLI all requested medical and mental health information, and all other material information regarding Participant’s physical and mental health. Medical conditions (including but not limited to allergies, pregnancy, genetic conditions, diseases, infections, injuries, medication needs, disabilities, phobias, or other mental health conditions) can cause or contribute to problems for Participant and others during the Programs, and failure to disclose any such conditions could result in serious risk to Participant and others. It is important for WLI to be informed and aware of any potential problems that may arise. WLI and its staff are not medical experts, but can use this information to assist in avoiding or managing issues. The conditions of each Participant can impact themselves and others during the course of the Programs.

Participant represents and warrants that they will notify WLI regarding any changes in physical or mental health conditions that may occur, either before or during the Programs.

Participant is aware that injuries or illnesses during Programs may occur far from rescue personnel, and that it may take rescue personnel a long time to locate and reach an injured or ill person, or for the injured or ill person to be evacuated and brought to a professional medical facility. What could be a minor injury in an urban setting could result in major complications or even death in the backcountry.

Participant agrees and consents that, if they become injured, ill, or has any type of impaired capacity during the Programs, WLI staff may respond to the situation as deemed advisable or necessary, in WLI’s sole discretion. Participant authorizes WLI to transfer their care to any medical provider including but not limited to emergency responders, paramedics, ambulance transportation, mental health professionals, doctors, and hospitals including medication, anesthesia and surgery. Participant agrees to be solely responsible for the costs of any such treatment, and agrees to defend, indemnify, and hold harmless WLI regarding any such costs.

Prospective participants under the age of 18 years are required to have a parent or legal guardian read and sign.

Name of Participant
Participant DOB
Name of Parent/Legal Guardian
Relation

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Signed by Josh Jackson
Signed On: September 2, 2020

Signature Certificate
Document name: WFR - 5-Day - WLI Participant Agreement - Parent/Guardian
lock iconUnique Document ID: e0d2e04d76f711ef8fc237d7cfc334baab511cde
Timestamp Audit
July 31, 2020 8:38 pm PSTWFR - 5-Day - WLI Participant Agreement - Parent/Guardian Uploaded by Josh Jackson - info@wildlead.com IP 104.51.36.130