Please print and fill out this form if your ski appointment is with Challenge Mountain at Boyne Mountain. If your appointment is scheduled for Challenge Mountain, please click on link.
Challenge Mountain
2205 Springbrook Rd. Boyne Falls, MI 49713 (231)535-2141
Permission for Emergency Care Date____________________________
Volunteer / Client (circle one) Name__________________________________________
Address_________________________________________________________________
City______________________________State___________Zip____________________
DOB________________________Age____________Height_________ Weight_______
Parent/Guardian Name_____________________________________________________
Address if different than above______________________________________________
Phone______________________________Alternate Phone_______________________
Medical Insurance Information/ID#___________________________________________
Known Allergies__________________________________________________________
Current Medications_______________________________________________________
Name of Physician_____________________________Phone______________________
I _________________________________hereby give my permission for emergency care to be sought and/or given to myself or above named individual in the event that I cannot be contacted or am incapacitated.
Release of Liability/Consent
I am aware that injury or event death may occur to participants in this event. Some of the dangers involved in this activity include terrain changes, tree location, hill machinery and/or possible physical exertion. There are inherent risks involved with any Challenge Mountain activities. This event involves physical activity and exertion. I submit that the participant is in sound physical condition with no health problems that could be aggravated by participation in this event. I release and discharge Challenge Mountain, and Boyne USA, doing business as Boyne USA and their agents from all claims for damages arising directly or indirectly from applicant’s participation in such activity. I may or may not have inspected the equipment, site, and facilities. Nevertheless, I assume all risk associated with this event, participation in it, including but not limited to the conditions of the equipment, site(s), facilities, and the unknown ability of other participants. I give permission for the participants photograph to be used for media relations, fundraising, and identification of client for medical purposes. Furthermore, Challenge Mountain maintains volunteers of staff that have received citizen level CPR and first aid training. There volunteers act solely on their own accord and Challenge Mountain will not be held liable for their actions. The acts of volunteers are covered under the theory of Good Samaritan, which releases them from liability. Challenge Mountain will maintain infection control, first aid, and barrier protection. It is my express intent, by signing this release and participating in this event, to waive, relinquish, and release any claims, which I might have against any and all volunteers, directors, executive directors, officers, agents, and employees of both Challenge Mountain of Walloon Hills, Inc. and Boyne USA and also the organizations called Challenge Mountain of Walloon Hills, Inc. and Boyne USA. I intend this release of liability to be effective against me, my spouse, my heirs, successors, and assignees. I understand that this is a Challenge Mountain program which is being held at Caberfae Peaks and there is no liability to Boyne USA. as result of this event being held at this facility. I also understand that all above initialed information holds true for both organizations.
By signing the Release of Liability, I signify that I have read and understand it. I also understand that my participation is dependent upon my knowing and voluntary execution of this Release of Liability.
Print Name______________________________________
Signature__________________________________________________Date________________________