Risk Acceptance Form
Please complete the following form to acknowledge your acceptance of the risks associated with a specific activity.
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Activity
Please Select
Hiking
Rock Climbing
White Water Rafting
Skydiving
Bungee Jumping
Date of Activity
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
I acknowledge that the activity I am participating in involves certain risks and dangers.
Yes
No
I understand and accept that there may be risks associated with the activity which cannot be completely eliminated.
Yes
No
I agree to release and discharge the organizers, guides, and participants from any and all liability, claims, demands, actions, or causes of action arising out of my participation in the activity.
Yes
No
Signature
Submit
Should be Empty: