ACTIVITY PARTICIPATION FORM
Explorer Post 72
Arapahoe Peak—Mountain Climbing
Sunday, October 19, 1997

this is a legal document, signatures required for all participants

ACTIVITY DESCRIPTION AND RISK ACKNOWLEDGMENT

TRIP DESCRIPTION:
Members of Explorer Post 72, sponsored by Sacred Heart of Jesus Catholic Church, will participate in a mountain climbing trip of Arapahoe Peak. This is a relatively easy climb and does not require roped protection. This is a good climb for
beginners to learn mountain peek climbing techniques.  Explorers  should meet at the SCOUT ROOM, Sacred heart Church, at 6:00 AM on Sunday, October 19th, to depart for the Peak. A alternate activity will be conducted in the event of adverse weather.  Participants will notified if a decision is made to cancel the climb due to adverse weather, or if adverse weather occurs during the climb, the event may be discontinued.

ALL Participants (and parents of Explorers under age of 18) must read and sign this acknowledgment of risk. Trip leaders will be Andy Morris and Jeff and Pris Wagener. Crew Leader will be Ciaran Loomis.

NOTE THAT THIS TRIP MAY POSE CERTAIN RISKS OR HAZARDS BEYOND THE CONTROL OF THE TRIP SPONSORS, ADVISORS, AND PARTICIPANTS WHICH  MAY INCLUDE, BUT ARE NOT LIMITED TO  THE FOLLOWING:

WEATHER MAY VARY FROM NEAR PERFECT TO RAIN, LIGHTNING, WIND IN A MATTER OF MINUTES, SO PREPARATION WITH ADEQUATE CLOTHING IS ABSOLUTELY ESSENTIAL.
Peak Climbing may pose certain risks including hut not limited to rock fall, injury from falls, equipment malfunctions, or other risks associated with such activities.
Participants will be under supervision of experienced advisors, however, certain risks which may be beyond the control of said advisors and trip leaders may occur. It is expected that all participants will have adequate equipment for such a trip, and that participants are in good physical condition and be able to participate adequately under such conditions. Participants and parents/guardians of participants acknowledge the rigors and demands of this trip and understand that such risks may be inherent in the activity. While normal Scouting-safety procedures and guidelines are in effect at all times, it is acknowledged that certain risks beyond the control of trip leaders and/or advisors may occur, and that in recognition of such risks, I and/or my child :consent to participate in this event and accept the terms of the participation authorization, informed consent, release of liability, and medical treatment consent printed below:

** FOR ADDITIONAL INFORMATION CALL: CIARAN LOOMIS, CREW LEADER AT 652-3986
ADVISORS: ANDY MORRIS; JEFF AND PRIS WAGENER AT 499-1067
EMERGENCY CONTACT PHONE NUMBER: BOB AMICK 442-2342 (VOICE MAIL)

REQUIRED EQUIPMENT:
It is essential that all participants. have the following equipment: ·*(Climbing harness, rock helmet, carabiners, figure-8 rappel ring.) (Participants who do not have this equipment may borrow it from the post. Be sure to notify the crew leader what your needs are.) BE PREPARED FOR ADVERSE WEATHER:
water-resistant wind breaker, (nylon or gortex recommended) with hood, rain/wind pants,  two one-quart bottles, "space blanket" (mylar aluminized .plastic), fleece sweater or down vest, polypropylene or high bulk acrylic socks, wool socks, sturdy hiking boots or athletic shoes with lug or rubber grip soles, small personal first aid kit; any personal medications/prescriptions; insect repellent, small bottle (cutters/deepwoods off, etc.) Flashlight and extra batteries; SACK LUNCH, SUNSCREEN SPF30; WRAPAROUND SUNGLASSES WITH' UV FILTER LENSES Snacks, munchies, "gorp" in plastic bags, Small DAY PACK OR WAIST PACK, camera and film recommended. *(Explorers who do not have.)

SAFETY REQUIREMENTS AND CODE OF CONDUCT
In accordance with Longs Peak Council and BSA safety requirements, the following rule shall be strictly adhered to at times:. All participants shall follow the; Explorer Code and abide by the rules/decisions of the Clew Leader and Advisors at all times; any serious failure or violation of these rules shall be grounds for being returned home prior to the end of the trip. Parents agree  to accommodate such arrangements if need arises, BSA requires participants to stay in groups of no less than three persons at all time.
**PLEASE COMPLETE AND SIGN OPPOSITE SIDE OF THIS FORM
PLEASE KEEP ONE COPY AND SUBMIT THE COMPLETED: COPY BY OCTOBER 19th, 1997
PARTICIPATION AUTHORIZATION. INFORMED CONSENT, RELEASE OF LIABILITY AND MEDICAL TREATMENT CONSENT

I HEREBY CERTIFY THAT I HAVE READ AND FULLY UNDERSTAND THE NATURE AND SCOPE OF THE TRIP AS PROPOSED ABOVE, AND FURTHER UNDERSTAND THE POTENTIAL RISKS INHERENT IN SUCH TRAVEL AND PARTICIPATION AS DESCRIBED ABOVE. AND/OR IN MEETINGS WITH ADULT LEADERS. I THEREFORE AGREE TO AND ACCEPT THE RULES AND GUIDELINES FOR PARTICIPATION IN THE ACTIVITY AS DESCRIBED ABOVE. (FOR EXPLORER YOUTH UNDER THE AGE OF 18, PARENT/GUARDIAN CONSENT IS REQUIRED AS FOLLOWS): I AUTHORIZE PARTICIPATION BY MY CHILD IN THE ACTIVITY DESCRIBED ABOVE, AND CONSENT TO SUPERVISION OF MY CHILD BY ADULT ADVSOR/LEADERS DURING THIS EVENT. I UNDERSTAND THAT NORMAL SCOUTING SAFETY PROCEDURES AND LEADERSHIP GUIDELINES WILL BE IMPLEMENTED DURING THIS ACTIVITY. I FURTHER RECOGNIZE THAT CERTAIN RISKS MAY BE INHERENT IN THE CONDUCT AND PARTICIPATION IN THIS ACTIVITY WHICH MAY BE BEYOND THE CONTROL OE ADULT LEADERS AND/OR ACTIVITY SPONSORS.  I FURTHER CERTIFY THAT I AND/OR MY CHILD IS/ARE MEDICALLY AND PHYSICALLY CAPABLE OF PARTICIPATION IN THIS EVENT AND IS/ARE MEDICALLY CLEARED BY A PHYSICIAN FOR PARTICIPATION IN SUCH ACTIVITIES.  IN RECOGNITION OF THE BENEFITS DERIVED BY MYSELF AND/OR MY CHILD, AND IN THE EVENT OF ANY ACCIDENT RESULTING IN INJURY, ILLNESS, DISABILITY, OR DEATH, OR PROPERTY LOSS OR DAMAGE, WHICH MIGHT OCCUR TO MYSELF AND/OR MY CHILD, WHILE TRAVELING TO OR FROM, OR DURING THE CONDUCT OF, THIS EVENT, I AGREE TO INDEMNIFY, AGREE NOT TO SUE, AND AGREE T0 HOLD HARMLESS, THE BOY SCOUTS OF AMERICA, EXPLORER POSTS 72 AND 007, TRIP SPONSORS,. ADVISORS, LEADERS, OTHER TRIP PARTICIPANTS.  SACRED HEART OF JESUS CATHOLIC CHURCH, SACRED HEART OF MARY CATHOLIC CHURCH, AND ANY OR ALL AGENTS, EMPLOYEES,  REPRESENTATIVES (OR THEIR EXECUTORS OR HEIRS) ACTING ON BEHALF OF SUCH ORGANIZATIONS OR INDIVIDUALS, FROM ALL CLAIMS DAMAGES, LOSSES, INJURIES AND EXPENSES ARISING OUT OF OR RESULTING FROM PARTICIPATION IN THESE ACTIVITIES.  I AGREE THE SITE OF ANY LAWSUIT AND THE LAW GOVERNING ANY SUCH LAWSUIT SHALL BE COLORADO AND GOVERNED BY COLORADO LAW. THE TERMS OF THIS AGREEMENT SHALL CONTINUE AND BE IN EFFECT AFTER THE TRIP HAS ENDED.  AS LIQUIDATED DAMAGES, I HEREBY AGREE THAT IF THE BOY SCOUTS OF AMERICA OR ANY OF THE INDIVIDUALS OR ORGANIZATIONS NAMED ABOVE IS FORCED TO DEFEND ANY ACTION, LAWSUIT OR LITIGATION INITIATED BY MYSELF, MY EXECUTORS, OR MY HEIRS, ON MY FAMILY'S OR MY BEHALF, MY HEIRS OR EXECUTORS AND I AGREE TO PAY THE BOY SCOUTS OF AMERICA AND ANY OR ALL SUCH ORGANIZATIONS OR INDIVIDUALS NAMED ABOVE, ANY COSTS AND ATTORNEY'S FEES INCURRED IF THEY SUCCESSFULLY DEFEND SUCH ACTION, LAWSUIT, OR LITIGATION.

*MEDICAL TREATMENT CONSENT:
 IN THE EVENT OF INJURY OR ILLNESS TO MYSELF AND/OR MY CHILD, I CONSENT TO ADMINISTRATION OF SUCH FIRST AID MEASURES AS MAY BE DETERMINED NECESSARY BY ACTIVITY LEADERS, AND IF DETERMINED NECESSARY. I FURTHER CONSENT TO TRANSPORT BY GROUND OR AIR AMBULANCE AND/OR REFERRAL TO PHYSICIANS AND ADMISSION TO HOSPITALS. I FURTHER CONSENT TO EMERGENT MEDICAL TREATMENT FOR MYSELF AND/OR MY CHILD IF DETERMINED NECESSARY, INCLUDING BUT NOT LIMITED TO, ANESTHESIA. INJECTION. SURGERY, X-RAY. AND MEDICATION, IF I CANNOT BE CONTACTED IMMEDIATELY FOR SUCH CONSENT. I UNDERSTAND THAT REASONABLE EFFORTS WILL BE MADE TO CONTACT ME IN SUCH CASES. PHONE NUMBER WHERE I CAN BE REACHED DURING THIS EVENT IS LISTED BELOW:
*MEDICAL INSURANCE CERTIFICATION:
I HEREBY CERTIFY THAT MEDICAL INSURANCE 1S IN EFFECT FOR THE BELOW NAMED PARTICIPANT AS FOLLOWS:
NAME OF COMPANY/PROVIDER/HMO:______________________________________________________________________________________
POLICY NUMBER:_____________________________________________ EXPIRATION_______________________________________________
PHONE NUMBER OF COMPANY FOR AUTHORIZATION IF NEEDED:____________________________________________________________
PARENT AND PARTICIPANT SIGNATURES
I hereby certify that I have read understand and agree without reservation to the contents and requirements of this document and the nature and possible risks of participation in this activity, and that I accept and acknowledge such risks in light of the benefits of such participation.

WITNESS MY HAND AND SEAL THIS____________________ DAY OF______________ 1997, AT BOULDER, COLORADO, U.S.A.

X______________________________________________ ADDRESS___________________________________ city____________________PHONE____________________
 Signature of Participant
_____________________________________________________________________________________________________________________________________________
FULL NAME OF PARTICIPANT (PLEASE PRINT)
address:_______________________________________________city_________________________________zip________________ phone________________________
NOTE: SIGNATURE(S) OF PARENTS/GAURDAIN(S) REQUIRED FOR PARTICIPANTS UNDER AGE 18

X______________________________________________________ PHONE_________________________________________________
Signature of Parent/ Guardian

X______________________________________________________ PHONE_________________________________________________
Signature of Parent/ Guardian
X nearest relative (or other person to contact if parent/guardian unavailable)_________________________________________________        
PHONE ___________________________

X EXPLORER ADVISOR APPROVAL: X (SIGNATURE)____________________________________________________________

DRIVER INFORMATION
O  I PLAN TO PARTICIPATE IN THE CLIMB ON SUNDAY MORNING.
O OTHER ARRANGEMENT (SPECIFY)_____________________________________________________________________________
O NUMBER OF PASSENGERS I CAN TAKE (SEAT BELT REQUIRED FOR EACH PASSENGER)_______________________________________________
MAKE OF VEHICLE______________________________________________________________YEAR___________________
DRIVER'S LICENSE NUMBER_________________________________________________ STATE ____________________
INSURANCE CERTIFICATION: I CERTIFY THAT LIABILITY INSURANCE IS IN EFFECT FOR THIS -VEHICLE IN THE AMOUNTS OF $50,000, $100,000, AND $50,000 AS SPECIFIED IN B.S.A AND STATE OF COLORADO REQUIREMENTS.
ALL PASSENGERS ARE REQUIRED TO WEAR SEAT BELTS DURING TRAVEL: B.S.A POLICY
SIGNATURE OF DRIVER (REQUIRED)X _____________________________________________________ DATE __________________