Liability Release Form
RELEASE AND WAIVER OF LIABILITY,
ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT
IN CONSIDERATION for being permitted to participate in activities (the “Activities”) on or about the Boulder Crest Retreat
facilities owned and operated by Boulder Crest Foundation (the “Foundation”), I, for myself, the Minor (as defined below,
if applicable) and for my and the Minor’s personal representatives, assigns, heirs and next of kin, do hereby RELEASE,
WAIVE, FOREVER DISCHARGE, COVENANT NOT TO SUE, AGREE TO INDEMNIFY, AND SAVE AND HOLD
HARMLESS, the Foundation, its officers, directors, agents, affiliates, employees, volunteers and their respective successors
and assigns (collectively, the “Released Parties”) from any and all claims, demands, losses, actions, liabilities, and causes of
action of any sort, known or unknown, foreseen or unforeseen, including, but not limited to, death, bodily injury, or
property damage that I (or the Minor, if applicable) might sustain or suffer resulting from, or in any manner connected with,
my (or the Minor’s, if applicable) participation in the Activities, including, without limitation those caused by the
negligence, wrongful acts, or omissions of the Foundation or the Released Parties.
1. I ACKNOWLEDGE that the Activities may include, among other things, lodging, swimming, canoeing, kayaking,
tubing, fishing, hiking, biking, archery, and being in close proximity to horses and other animals and wildlife. I acknowledge, agree,
and represent that I understand the nature of the Activities and that I am qualified, in good health and proper physical condition and
have sufficiently prepared or trained for participation in the Activities, and have not been advised to refrain from participating in the
Activities by any health professional. I certify that there are no health-related reasons or problems which preclude my participation
in the Activities. I further agree and warrant that if at any time I believe conditions to be unsafe, I will immediately discontinue
further participation in the Activities.
2. I FULLY UNDERSTAND THAT: (a) THE ACTIVITIES INVOLVE RISKS AND DANGERS OF SERIOUS
BODILY INJURY, INCLUDING PERMANENT DISABILITY, PARALYSIS, AND DEATH (“RISKS”); (b) the Risks may be
caused by my own actions or inaction, the actions or inaction of the Minor, or the actions or inaction of others participating in the
Activities, the condition in which the Activities take place, or THE NEGLIGENCE OF THE RELEASED PARTIES NAMED
ABOVE; (c) the Risks may be caused by terrain, facilities, temperature, weather, condition of participants, equipment, vehicular
traffic, and lack of hydration; and (d) to participate in the Activities, I (and the Minor, if applicable) must be covered by personal
medical insurance and I (and the Minor, if applicable) agree to recover all damages first from such insurance carrier for any and all
injuries that occur in connection with the Activities. I acknowledge that there may be OTHER RISKS AND SOCIAL AND
ECONOMIC LOSSES either not known to me or not readily foreseeable at this time, and I FULLY ACCEPT AND ASSUME ALL
RISKS AND OTHER SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS AND DAMAGES that I (and the
Minor, if applicable) incur as a result of my participation and/or that of the Minor in the Activities.
3. I hereby consent to receive medical treatment (for myself, or on behalf of the Minor, if applicable) which may be
deemed advisable by Foundation staff in the event of injury, accident, and/or illness during the Activities.
4. [APPLIES ONLY IF PARTICIPANT IS UNDER AGE 18] AS THE PARENT AND/OR LEGAL GUARDIAN OF
THE PARTICIPANT LISTED BELOW (THE “MINOR”), I UNDERSTAND THE NATURE OF THE ACTIVITIES AND THE
MINOR’S EXPERIENCE AND CAPABILITIES AND BELIEVE THE MINOR TO BE QUALIFIED, IN GOOD HEALTH, AND
IN PROPER PHYSICAL CONDITION TO PARTICIPATE IN SUCH ACTIVITIES. I FURTHER AGREE AND WARRANT
THAT IF AT ANY TIME I BELIEVE CONDITIONS TO BE UNSAFE, I WILL IMMEDIATELY DISCONTINUE THE
MINOR’S PARTICIPATION IN THE ACTIVITIES.
I HAVE READ THIS DOCUMENT CAREFULLY, FULLY UNDERSTAND ITS CONTENTS, INCLUDING THE INDEMNITY
CONTAINED HEREIN, AND INTEND THE RELEASE TO BE A COMPLETE AND UNCONDITIONAL RELEASE AND
WAIVER OF LIABILITY TO THE FULLEST EXTENT PERMITTED BY LAW. IF ANY PROVISION(S) OF THIS
AGREEMENT IS HELD TO BE INVALID OR UNENFORCEABLE, THE REMAINING PROVISIONS SHALL NOT BE
AFFECTED AND SHALL CONTINUE IN FULL FORCE AND EFFECT. THIS AGREEMENT SHALL BE GOVERNED IN
ALL RESPECTS BY THE LAWS OF THE COMMONWEALTH OF VIRGINIA WITHOUT REGARD TO ITS LAWS OR
REGULATIONS RELATING TO CHOICE OF LAWS.