Challenge Course Release of Liability Form

Any person using the Challenge Course must sign a Release of Liability Form to participate. 

Please complete and return to Your Team Wins.  

Medical Information:

I am aware that participating in any physical activity may be dangerous. 

Because of the inherent dangers of participation in such activities,

I recognize that importance of following directions of the facilitator/instructor

and agree to obey such facilitator/instructor to the best of my ability.

So that a facilitator/instructor may be properly informed,

I fully disclose the following medical information. (If “nothing,” please so indicate).

I am currently under a doctor’s care for: ___________________________________

_______________________________________________________________________.

I am currently taking the following medication(s): ___________________________

_______________________________________________________________________.

I am allergic to the following medication(s) or allergen(s): ____________________

_______________________________________________________________________.

The following medical condition(s) might affect my participation: ____________

______________________________________________________________________.

Release of Liability:

I understand that part of the Your Team Wins Challenge Course program may be physically and/or

emotionally demanding.  I affirm that my health is good, and that I am not under a physician’s care

for any undisclosed condition that bears upon my fitness to participate in Challenge Course activities. 

I understand that each participant must assume the risk of physical injury that could result from any

of these activities.  I hereby consent to first aid and/or emergency medical care for treatment of injuries

that I may sustain while participating in any activity associated with Your Team Wins Challenge Course. 

I understand that by signing this, I hereby release Your Team Wins, its owners, officers, employees,

agents and all individuals assisting in the instruction and conduct of the Challenge Course activities

from any and all liability.  I have carefully read this Release of Liability and fully understand its content.

Participant Signature:  ______________________________ Date:  _____________

Participant Print name:  _____________________________

Parent/Guardian Signature (if under 18): ______________ Date:  ______________