Date of Birth (dd/mm/yyyy)
Please fill out all medical information. If no condition exists please enter "none".
Current Health Status
List ALL Medical Conditions/Disorders/Disabilities/ Behavioral Problems
Any Additional Information
Please list any activities which you do not want your child participating in
Participants T-shirt size
My Child has permission to participate in the Galena Outdoor Adventure Program. I have provided Galena Lodge with all accurate information and have not falsified any records including but not limited to age and medication requirements.
Acknowledgment of Risk: I understand there are inherent and other risks of injury involved in camping and outdoor adventure and recreational activities, including travel to and from these activities. I understand that these risks are impossible to eliminate fully by even the most careful and prudent planning and conduct by Galena Youth Adventure Camps. I voluntarily accept these risks to my child. I agree to RELEASE FROM LIABILITY and to INDEMNIFY AND HOLD HARMLESS Galena Lodge, Zepler World Industries, Blaine County Recreation District, USDA, and its agents and directors from any direct, indirect, special, incidental or consequential or punitive damages, including any loss, damage, cost, or injury, that arises from participation in any activity connected with the aforementioned activities and Galena Camp, whether based on a theory of contract, tort, strict liability or otherwise. I/We understand that I/We are waiving our right to take legal action including filing a lawsuit for personal injuries to our child(ren) and/or ourselves. The venue of any dispute that may arise out of this agreement or otherwise between the parties to which Galena Youth Adventure Camp or its agents is a party shall be Idaho State Court in Blaine County, Idaho.
I HAVE CAREFULLY READ, FULLY UNDERSTAND AND AGREE TO ALL TERMS OF THIS RELEASE AND INDEMNITY AGREEMENT, THE CANCELLATION POLICY, AND TO ALL ADDITIONAL CAMP POLICY LISTED IN THE FIRST 4 PAGES OF THE CAMP INFO PACKET.
Galena Parent/ Legal Guardians Signature
Date Signed (dd/mm/yyyy)
WHITE OTTER ACKNOWLEDGEMENT OF RISK
WE REQUIRE ALL GUESTS TO READ AND SIGN
I, the undersigned, do expressly covenant and state that my child is a member of a trip with WHITE OTTER
ADVENTURES and is participating therein as part of a joint enterprise and assume all risks in said trip for and any minor children
in my custody. I have informed WHITE OTTER of any pre-existing medical situation of which they should be aware. I
understand that I am to be financially responsible for any medical treatment and necessary evacuating resulting from participation
in this trip.
I hereby acknowledge that I fully understand that there are inherent risks in whitewater and other outdoor trips and
transportation to and from the river. These risks are impossible to eliminate fully by even the most prudent and careful planning
and conduct by WHITE OTTER. Potential risks may include vehicle accident, loss of or damage to personal property, immersion
in water and hypothermia, collision with boat, rock, log, fallen tree, injury or fatality due to capsize of a boat, falling while aboard
a boat or on shore, exposure to temperature extremes or inclement weather, or other risks not listed here.
I am of sound mind and am undertaking this activity of my own free will for myself (and any minor children in my
custody), and by signing this statement I take full responsibility for my own (and my minor children’s) welfare and waive any
future claims against WHITE OTTER, except in the case of gross negligence. I specifically release WHITE OTTER, its officers,
guides, agents, employees, and owners from any and all liability as to any right of action or claim to relief that may occur to me or
to my heirs or personal representatives for any such personal injury, loss of life, loss of consortium, or loss of or damage to
property which I may suffer while participating in the whitewater trip, transportation to and from the river, or any other activities
that I (or my minor child) may engage in. The terms here shall serve as a release and express assumption of risk for myself, my
heirs, executors, and administrators and for all members of my family, including any minor children in my custody.
I understand that other trip members, professional photographers, or WHITE OTTER may wish to make photographic or
video use for personal and promotional purposes, and I hereby grant permission for them to do so with out recourse and without
compensation to me.
The venue of any such dispute that may arise out of this agreement or otherwise between the parties to which WHITE
OTTER OUTDORR ADVENTURES or its agents is a party shall be either town of Ketchum, Idaho Justice Court or the State
Supreme Court in Blaine County.
I HAVE READ THE ABOVE WAIVER AND RELEASE AND BY SIGNING IT AGREE IT IS MY INTENTION TO EXEMPT
AND RELIEVE WHITE OTTER FROM LIABILITY FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL
DEATH CASUSED BY NEGLIGENCE OR ANY OTHER CAUSE.
White Otter Parent/ Legal Guardians Signature
Date Signed (dd/mm/yyyy)
HORSEBACK RIDE - ASSUMPTION OF RISK FORM FOR PIONEER OUTFITTERS LLC
PLEASE FILL OUT FORM EVEN IF YOUR CHILD DOES NOT CURRENTLY WISH TO GO HORSEBACK RIDING
Please check here if you want your child to go horseback riding Please check here if you do not currently want your child to go horseback riding but you may change your mind (You will need to make a decision and tell the counselors when you drop off your child on Monday morning.) Please check here if you do not want your child to go horseback riding and there is no possibility that you may change your mind.
Pioneer Outfitters LLC/Redfish Corrals/Galena Stage Stop Corrals provides many outdoor recreational activities to the public. Trip participants understand that outdoor recreational activities do involve inherent risks which are beyond the control of
Pioneer Outfitters LLC Ranch/Redfish Corrals/Galena Stage Stop Corrals, and their staff, agents and employees.
We, the undersigned, do understand that upon acceptance of the horse and equipment that we hereby assume all risks and responsibilities for my behavior, actions and safety, and for the behavior, actions and safety of my minor child or children while involved in the activities.
Therefore, I assume full responsibility for personal injury to myself and/or to members of my family, or for loss or damage to my personal property and expenses thereof as a result of my negligence or the negligence of my family participating in said activities.
I have read and understand this agreement and do voluntarily agree to sign.
Pioneer Outfitters LLC Parent/ Legal Guardians Signature
Pioneer Outfitters LLC Date (dd/mm/yyyy)
I have read and understand this agreement and by initialing below I fully accept the above stated terms.