additional participant registration

Name

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Birth

YYYY

Emergency Contact Name

First Name

Last Name

Emergency Contact Phone

(###)

###

####

Gender

Ethnicity

Choose the option which fits you best.

Race

Choose the option which fits you best.

Do you have a disability?

Are you a veteran?

Do you currently have any medical, physical, mental, or emotional conditions that may impact your participation in this trip?

This does not mean you cannot participate, but it is important that trip leaders have this information to best support your wellbeing.

If yes, please describe.

Please list any allergies we should be aware of. Include their severity and what you do for treatment.

If none, enter N/A.

Please list any medications we should be aware of. Include their name and dosage.

If none, enter N/A.

Please list any dietary restrictions we should be aware of.

This is important so crew leaders can plan meals accordingly. If none, enter N/A.

Have you volunteered with GBCA before?

How did you hear about this event?

Are you affiliated with any groups?

Clearwater Trekking, Here Montana, Idaho Trails Association, Lochsa Lodge, Rocky Mountaineers, Spokane Mountaineers, the Narrow Way, University of Montana, Wild Montana, Women Who Explore, or other.

Release of Liability

I would like to attend a Volunteer Stewardship Trip sponsored by the Great Burn Conservation Alliance (“GBCA”). I am at least 18 years of age (or, if I am younger than 18 years of age, my parent or guardian must also agree to this Release of Liability) and in good health. I am physically fit to participate in the activity, and am not aware of any allergies or other physical or mental disorder or condition that would warrant against my participation on this trip. I am aware and acknowledge that the trip may be hazardous, and that such hazards may include but are not limited to rockfall, wildlife interactions, lightening, inclement weather, accident, illness, Giardia, heat exhaustion, and the hazards of road and highway travel, and may result in loss, injury or death. I will not hold GBCA, its officers, directors, employees, leaders, volunteers, and/or agents, or any other sponsoring organization, responsible for these or other hazards. Because the Volunteer Trip will occur in a backcountry setting, I understand that emergency medical care may not be readily available. I understand that participation in this program may require a degree of skill and knowledge different from other activities, and that I have responsibilities as a participant. I will follow all directions from representatives of the GBCA, and comply with all applicable rules for backcountry travel as they are explained or known to me. I understand that there may be times when trip participants are unsupervised for portions of field activity, and will ultimately be held responsible for their own safety. I will additionally follow any and all other relevant rules and regulations (e.g., motor vehicle laws). In return for my receiving permission from the GBCA to participate on the trip, and for other good and valuable consideration, I fully release and indemnify GBCA, as well as its respective officers, directors, employees, leaders, volunteers, and agents, from all liability, claims, demands, and causes of action, arising out of damage, loss, or injury to me (including death) or to my property, from whatever cause, as a result of their acts or omissions, including their negligence, or my participation in a trip or other activity, and I covenant and agree to not file or assert any claim, demand or lawsuit against any of the released parties. I intend this Release of Liability to be broadly construed for the benefit of the released parties and to be binding upon my family, heirs, personal representatives, and insurers. I grant GBCA permission to utilize photographs or videos taken by me or of me participating in the above activity/trip for the purpose of promotion and advertising. I waive any right to inspect or approve the finished product, including written copy that may be created in connection therewith. In addition, I waive any right to compensation, financial or otherwise, for such use. BY SIGNING THIS RELEASE OF LIABILITY, I ACKNOWLEDGE THAT I HAVE CAREFULLY READ, UNDERSTAND, AND VOLUNTARILY AGREE TO ALL ITS PROVISIONS. I RECOGNIZE THAT BY SIGNING THIS RELEASE OF LIABILITY I AM GIVING UP LEGAL RIGHTS I MAY OTHERWISE HAVE.