- Bear Basin Ranch - 473 Country Road 271 - Westcliffe, Colorado 81252
Phone 719 783-2076 fax: 866 244-4691
Trip Name__________________Departure Date________Trip Option ___________________________ Name_________________________Occupation_____________Email__________________________
Age____Sex___Height____Weight_____ Have you been on a previous guided adventure trip?______
Describe horseback and /or outdoor experience_______________________________________________________________________
Describe your physical fitness level___________________________________________________________________________
Do you exercise regularly?describe_____________________________________________________
Describe health/medical conditions________________________________________________________________________
Do you smoke?______Dietary restrictions/preferences?_____________________________________
Who should we notify in case of emergency_________________________Phones________________________________________
I have insurance covering injury and health. Company___________________________Policy#______________________________________
How did you hear of us?____________________________________________________________________________
On international trips, hotel rooms are double occupancy. I prefer a single at extra charge. Yes___ No________ Citizenship__________Passport#___________________________________________
Exp. date__________Deposit enclosed ___Peru/Mex _____$350, Colorado $150____
Balance to be charged 45 days prior to departure $ ________
.Charge to MC_VISA__AE_#____________________________________Exp. Date_____
Have you read the detailed description for the trip? Yes_____
Important: Please read and fill out both pages of this form.
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Page 2 of 2.
VERY IMPORTANT. PLEASE READ CAREFULLY. THIS IS A LEGAL CONTRACT. YOUR SIGNATURE BELOW INDICATES THAT YOU UNDERSTAND THE FOLLOWING INFORMATION, TERMS AND CONDITIONS AND AGREE TO COMPLY.
PAYMENT AND REFUNDS: Reservations with deposits are accepted in the order received. The balance is due 45 days before departure. If you cancel, all but the non-refundable deposit will be returned if we receive written notice of cancellation at least 30 days before the trip. Payments will be retained on later cancellations unless we are able to fill the vacancy. We may cancel any departure due to insignificant booking or other reasons beyond our control. In such case, an immediate and full refund will be made of the amount paid Adventure Specialists. Itineraries and trips may be altered due to weather, trains, flight delays, sickness and other circumstances beyond are control. If any trip has to be altered or delayed by contingencies or circumstances beyond our reasonable control, the additional cost of changes and delay is the responsibility of the participant. No refunds will be given for unused services, lodging, meals, and transportation. No amount will be refunded after a trip has departed.
DEPOSITS: International trips require $350, Colorado trips require a $200 non-refundable deposit with each reservation. If less than 45 days, please send full payment.
INSURANCE: We recommend that you protect yourself with travel insurance covering accident, trip cancellation, and emergency evacuation, available from any travel agency.
GUEST RESPONSIBILITY: It is vital that persons with medical problems make them known to us well before departure. Trip members have a responsibility to select a trip appropriate to their ability and interest. The trip leader has the right to disqualify anyone at any time if he or she feels the trip member is incapable and/or a members participation will endanger the member or others of the group. Failure to adhere to directions established by the trip leaders may result in being asked to leave the trip. If you leave the trip for any reason, you are responsible for all incurred expenses. No refund will be given.
My signature below certifies that I have carefully read all of the above contract and understand and agree to comply with all of it's terms and provisions. I certify that I have read the detailed description of the trip that I am joining an am physically/mentally capable of participation. I am in good health and physical condition. I am voluntarily participating with knowledge that dangers are involved and agree to assume all risk.
Parent or Guardian sign if under 18
This is not the liability release form. As a condition of participating in one of our adventure programs, we require that you read, understand and sign the PARTICIPANT AGREEMENT, RELEASE, AND ASSUMPTION OF RISK form. (Please be sure to send in both forms when you make your reservation.)
IF YOUR TRIP INVOLVES RIDING HORSES YOU MUST EITHER SIGN THE HELMET REFUSAL STATEMENT INCLUDED WITH THE WAIVER OR WEAR A HELMET.
Adventure Specialists Inc
and Bear Basin Pack Trips LLC
PARTICIPANT AGREEMENT, RELEASE, AND ASSUMPTION OF RISK OF RISK
In consideration of the services of Adventure Specialists Inc, and Bear Basin Pack trips LLC, their agents, owners, officers, volunteers, participants, employees, and all other persons or entities acting in any capacity on their behalf (hereinafter collectively referred to as "AS"), I hereby agree to release, indemnify, and discharge AS, on behalf of myself, my children, my parents, my heirs, assigns, personal representative and estate as follows:
1. I acknowledge that my participation in outdoor adventure based activities such as horseback riding and pack trips, treks, cattle drives, hiking trips, expeditions, river travel, mountaineering, rock climbing, hunting and bike tours entails known and unanticipated risks which could result in physical or emotional injury, paralysis, death, or damage to myself, to property, or to third parties. I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activity. Furthermore, AS guides have difficult jobs to perform. They seek safety, but they are not infallible. They might be unaware of a participant's fitness or abilities. They might misjudge the weather, the elements, or the terrain. They may give inadequate warnings or instructions, and the equipment being used might malfunction.
2. Backcountry and international travel has danger and risk. I acknowledge that risk exists including among other things: hazards of travel in jungle, mountains, high altitude, steep terrain, weather, travel by boat, raft, plane, truck, train, horse, foot, bicycle and other conveyance, forces of nature, slips and falls, rockfall, falling, exposure to insect and snake bites, the risk of altitude and cold, my physical condition, crime, civil unrest, injury or illness in remote areas without means of rapid evacuation or adequate medical care, supplies, or facilities. I agree that AS shall have no liability regarding the adequacy of medical care and supplies that may be provided.
3. Horseback riding is an inherently risky and dangerous activity. A horse, regardless of its training and usual past behavior, may act unpredictably at times based upon instinct or fright which may cause you to be thrown from or injured by the horse. We may encounter bears, puma, snakes and even small insignificant objects which frighten horses. Horses may bite, kick, buck, fall, or stumble. You or Your horse may collide with obstacles, cows, other horses, barbed wire, trees, branches, natural and man made objects whether obvious or not. Each of these obstacles and variations in terrain such as rivers, ditches, steep slopes, poor trails, holes, could cause you to lose control of your horse and be injured. Saddles may slip and tack or saddle problems may develop as a result of normal use and wear. Riders may lose their balance which can result in falling from the horse. I acknowledge that if I ride or travel with horses, I am subject to injury and no form of planning can remove the danger.
4. I expressly agree and promise to accept and assume all of the risks existing in this activity. My participation in this activity is purely voluntary, and I elect to participate in spite of the risks.
WARNING!... under Colorado law, an equine professional is not liable for an injury to or the death of a participant in equine activities resulting from the inherent risks of equine activities, pursuant to section 13-21-119, Colorado Revised Statutes.
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5. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless AS from any and all claims, demands, or causes of action, which are in any way connected with my participation in this activity or my use of AS's equipment or facilities, including any such claims which allege negligent acts or omissions of AS.
6. Should AS or anyone acting on their behalf, be required to incur attorney's fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs.
7. I certify that I have adequate insurance to cover any injury or damage I may cause or suffer while participating, or else I agree to bear the costs of such injury or damage myself. I further certify that I have no medical or physical conditions which could interfere with my safety in this activity, or else I am willing to assume - and bear the costs of - all risks that may be created, directly or indirectly, by any such condition.
8. In the event that I file a lawsuit against AS, I agree to do so solely in the state of Colorado, and I further agree that the substantive law of that state shall apply in that action without regard to the conflict of law rules of that state. If I, or anyone acting on their or my behalf, should bring such suit, that I/they shall pay all reasonable attorney fees, court and costs of defense should I/they not prevail.
I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect.
By signing this document, I acknowledge that if anyone is hurt or property is damaged during my participation in this activity, I may be found by a court of law to have waived my right to maintain a Lawsuit against AS on the basis of any claim from which I have released them herein.
I have had sufficient opportunity to read this entire document. I have read and understood it, and I agree to be bound by its terms.
Signature of Participant:________________________Print name__________________________
PARENT'S OR GUARDIAN'S ADDITIONAL INDEMNIFICATION
(Must be completed for participants under the age of 18)
In consideration of____________________(print minor's name) ("Minor) being permitted by AS. to participate in its activities and to use its equipment and facilities, I further agree to indemnify and hold harmless AS from any and all claims which are brought by, or on behalf of Minor, and which are in any way connected with such use or participation by Minor.
Parent or Guardian____________________print name________________________Date_______
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PROTECTIVE EQUESTRIAN HEADGEAR REFUSAL AGREEMENT
I, for myself and/or on behalf of my child or legal ward, have been fully warned and advised by Adventure Specialists, Inc. (hereinafter collectively referred to as "AS"), that we should purchase and/or wear a properly fitted and secured ASTM/SEI (Equestrian standard) certified helmet while riding or being around horses (whether on the premises of Adventure Specialists, Inc. or off the premises) in order to reduce the severity of some of our head injuries and to possibly prevent my/our death from happening as the result of a fall(s) or any other occurrence associated with this activity. We realize that we are subject to injury from this activity and that no form of preplanning can remove all of the danger to which we are exposing ourselves. Against the advice of AS, the guide/instructor, numerous court cases and AS's insurance company, we are refusing this critical safety precaution.
SIGNER STATEMENT OF AWARENESS
I/we the undersigned, have read the foregoing statement carefully before signing and do understand its warnings and assumption of risks.
Signature of Rider (spouse must sign for themselves)
Signature of parent, guardian and or spouse
Name of additional minor (s) rider (s)
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Phone 719 783-2076 fax: 866 244-4691
Bear Basin Ranch
Couty Road 271
Westcliffe, Colorado USA 81252