Name *

First Name

Last Name

Phone *

(###)

###

####

Will you be bringing a dog? *

On a trial basis this season, we will be allowing dogs to accompany their owners on the trails.

Yes

No

Release of Liability by/of Laurentian House *

Please read and be certain you understand the implications of agreeing below. 1. I do hereby affirm and acknowledge that I have been fully informed of the inherent hazards and risks associated with hiking, cycling, skiing, and snowshoeing, transportation of equipment related to the activities , and travelling to and from activity sites, in which I am about to engage. 2. Inherent hazards and risks include but are not limited to: a) Risk of injury from the activity and equipment utilized is significant including the potential for permanent disability and death. b) Falling, causing broken bones, severe injuries to the head, neck and back which may result in severe impairment or even death. c) All "Act of nature", including but not limited to avalanche, rock fall, inclement weather, thunder and lightning, severe and/or varied wind, temperature and other weather conditions. d) Risks associated with crossing, climbing or down-climbing of rock, snow and/or ice. e) Possible equipment failure and/or malfunction of my own or others' equipment, which may have been rented, borrowed, or personally owned. f) My own negligence and/or the negligence of others. g) Cold weather and heat related injuries and illness including but not limited to frost nip, frost bite, heat exhaustion, heat stroke, sunburn, hypothermia and dehydration. h) Attack by or encounter with insects, reptiles, and/or animals. i) Accidents or illness occurring in remote places where there are no available medical facilities. j) Fatigue chill, and/or dizziness, which may diminish my/our reaction time and increase the risk of accident. k) My sense of balance, physical coordination, and ability to follow instructions. *I understand the description of these risks is not complete and that unknown or unanticipated risks may result in Injury, illness, or death. I HEREBY RELEASE AND HOLD HARMLESS WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER CAUSED BY NEGLIGENCE OR OTHERWISE, the following named persons or entities, herein referred to as releasees, Owners (Taessa Chorny and Mathew Lincez) and Laurentian House.

I accept

I do not accept, and thus can't enjoy on the Laurentian House property.