First Name *

Last Name *

Email *
Please enter a GVSU student email address ending in @mail.gvsu.edu.

Phone *

Age by the date of the trip *
- Select Option Under 18 18-20 years 21+

Parent/ Legal Guardian Name *

Parent/ Guardian email address *

Have you gone whitewater rafting before? *
- Select Option Yes No

What interests you most about this trip/ what do you hope to get out of it and what, if anything are you most nervous about? *

Emergency Contact Name *

Relationship to you *

Phone *

The following questions have particular significance when immediate medical care is not readily accessible. Please answer as honestly as possible, to the best of your ability. Failure to complete this section will not affect your eligibility to participate but may help the leadership act appropriately in the event of an emergency. All responses will be confidential between you and the trip leaders.

Do you have any known allergies (food, medications, plants, animals, insects, etc.?
- Select Option Yes No

Please describe what you're allergic to, your typical reaction & treatment

Do you have any known medical conditions/ concerns that could affect your ability to fully participate or that are triggered by exercise?
Asthma
Diabetes
Epilepsy
High Blood Pressure
Major surgery within the last 2 years
Mental Health condition (anxiety, depression, etc.)
Recent Musculoskeletal Injury
None
Not listed Please specify a value for Do you have any known medical conditions/ concerns that could affect your ability to fully participate or that are triggered by exercise?

Please describe your condition/ concern, trigger(s), how it affects you and typical method of control/ treatment.

Some meals will be provided by Outdoor Adventures. What dietary restrictions do you have that we need to consider?
Food Allergy
Gluten Sensitivity
Lactose Sensitivity
Vegan
Vegetarian
None
Not listed Please specify a value for Some meals will be provided by Outdoor Adventures. What dietary restrictions do you have that we need to consider?

Please explain your dietary restrictions.

I hereby declare, assert, and affirm that my participation in the Grand Valley State University Outdoor Adventures (OA) trip (Trip) is done having voluntarily and knowingly assumed all risks involved in this event. The immediate physical risk(s) associated are those correlated with normal, vigorous physical activity. These risks include, but are not limited to, bodily discomfort and fatigue, muscular soreness, pulled or strained muscles, overuse injuries/soft tissue damage, bodily injury resulting from falls or misused equipment, environmental hazards such as extreme temperatures, weather, and encounters with flora/ fauna, and the rare instance of abnormal changes/responses of the cardiopulmonary system to exercise. Adverse responses include abnormal blood pressure, heart arrhythmias, and the very rare instance of heart attack, stroke, or sudden death.

In consideration of acceptance of this contract allowing my participation in the above stated Trip and intending to be legally bound thereby, I hereby for myself, my heirs, executors, administrators, and assigns, WAIVE AND RELEASE any and all rights and claims for negligence, injuries, damages, or losses that I may incur involved in the above stated Outdoor Adventures Trip, specifically Grand Valley State University, its respective employees, agents, representatives, successors, and assigns for any and all activities connected with the above Trip. If I am a Grand Valley employee (faculty or staff member), I also understand that I do hereby WAIVE any and all rights or benefits under the State of Michigan Worker’s Compensation laws for any injury incurred as a result of my participation in this event.

Should an accident or emergency occur, I hereby give permission to the OA staff that they may seek medical treatment on my behalf if in his or her judgement medical treatment is necessary. I agree to be responsible for any expenses incurred as a result.

By signing below I acknowledge that I have read and understand the acknowledgement of risk and release of liability and am voluntarily signing it. If any term or provision of this release shall be held illegal, unenforceable, or in conflict with any law governing the release, the validity of the remaining portions shall not be affected.

This is an OPTIONAL waiver. Failure to grant permission WILL NOT affect eligibility to fully participate in the trip.

By signing below, I hereby authorize Grand Valley State University to:

1. Record my likeness and voice on video, audio, photographic, digital, electronic or any other medium.
2. Use, reproduce, exhibit or distribute in any medium these recordings for any purpose that the University, and those acting pursuant to its authority, deem appropriate, including promotional or advertising efforts.

I give permission to Grand Valley State University to use, without charge and without reservation, my likeness in any medium and for any lawful purpose, including promoting the University, its programs and services.

I waive any rights of action I may have and release Grand Valley State University and its licensees from any and all claims I may have arising from my likeness, including any rights to sue for defamation or violation of my rights of
privacy and publicity.

In order to attend this trip, you must have your parent/ legal guardian sign, on your behalf, an acknowledgement of risk/ release of liability form (aka. the waiver). A pdf version will be emailed to you in the registration confirmation.