Acknowledgement and Assumption of Risk and General Release of Liability for Outdoor Adventure Activities
Please read carefully and be certain you understand the following before signing.
I. Acknowledgement and Assumption of Risk
I am aware that my voluntary participation in outdoor adventure activities offered by Destination Backcountry Adventures
LLC, exposes me to many potential risks, including the potential for severe injury or death. These risks include, but are
not limited to:
1. Rapidly changing and unpredictable weather that may cause injury directly (e.g. snow, rain, wind, lighting, extreme
hot or cold temperatures,) or indirectly (e.g. creating treacherous conditions, impairing the performance of equipment.)
2. All “acts of nature,” including, but not limited to, rock and tree fall, severe weather and extreme temperatures.
3. Risks associated with travelling and camping in the outdoors, including, but not limited to, encounters with insects,
reptiles, or other animals, harmful vegetation and fire.
4. Travel in steep, rocky, slippery and/or otherwise treacherous conditions on and off trail as well as in camp involves
the risk of slips, falls, and trips that may result in injury or death.
5. Activities on or near the water, such as backpacking, canoeing, kayaking, fishing, crossing rivers and wading involve
the risk of falling, capsizing or otherwise losing control in water that may be cold, contain currents/and or other natural or
man-made hazards.
6. Possible failure and/or malfunction, of my own or other’s equipment, which may have been rented, borrowed or
personally owned. Failure, break or malfunction may occur despite reasonable maintenance and use and may injure
when used as intended.
7. Destination Backcountry Adventures LLC staff make decisions on how to best minimize the inherent risks involved
with outdoor adventure activities based on a variety of perceptions and evaluations which by their nature are imprecise
and subject to errors in judgement.
8. Remoteness may enhance risks associated in engaging in outdoor adventure activities due to difficulty in
communicating with emergency facilities and/or personnel and the lack of easy access to medical facilities.
I am aware that this list represents some of, but not all, the risks inherent in outdoor adventure activities and a complete
listing of inherent and other risks is not possible and there are risks that cannot be anticipated. I agree to assume all
these risks and accept full responsibility for all risks identified herein and those inherent risks not specifically identified.
My participation is purely voluntary and I elect to participate in spite of and with full knowledge of the risks.
I acknowledge that the staff of Destination Backcountry Adventures LLC has been available to fully explain to me the
nature and physical demands of this activity and the inherent risks and dangers associated with this activity.
I, by initialing the line at the end of this sentence, expressly acknowledge that I have read and understood the above
Acknowledgement and Assumption of Risk. x____(Initial here)
Page 1 of 2, Please See Reverse Side
Destination Backcountry Adventures LLC
557 6th Ave, Suite #3R, Brooklyn, NY 11215
www.destinationbackcountryadventures.com
718.208.9878
Acknowledgement and Assumption of Risk and General Release of Liability for Outdoor Adventure Activities
Please read carefully and be certain you understand the following before signing.
II. General Release of Liability
I agree and understand that all outdoor adventure activities offered by Destination Backcountry
Adventures, (hereafter: DBA) including any transportation provided by DBA, shall be undertaken by me
at my sole risk and DBA, its owners, members, managers, employees, staff, guides, contractors,
volunteers, agents, and all other persons or entities associated with that business shall not be liable
for any damages, harm, or injuries, of any kind, nature or description to me or be subject to any action,
claim, demand or suit whatsoever for injury or damages, including, without limitation those resulting
from acts of active or passive negligence on the part of DBA. I, for myself and on behalf my
executors, administrators, heirs, assigns and successors release DBA from all such actions, claims,
demands, or suits. I, by initialing the line at the end of this sentence, expressly acknowledge that I have
read and understood this paragraph. x____(Initial here)
I acknowledge that I have entered into a contract the terms of which release DBA from any liability for
personal injury or property damage resulting from my participation in outdoor adventure activities with
DBA, whether or not any injury and/or damage results from DBA’s negligence. I, by initialing the line at
the end of this sentence, expressly acknowledge that I have read and understood this General
Release of Liabilityx____(Initial here)
I hereby give permission for transportation to any medical facility or hospital and I authorize for any
qualified guide or medical personnel to render necessary emergency medical care for my family or
myself.x____(Initial here)
In consideration of, and as part payment for, the right to participate with and utilize the services of
DBA, I have and hereby do assume all of the above-mentioned risks and will hold harmless DBA from
all claims demands, and liabilities whatsoever, both in law and equity, which may arise out of or in
connection with such activity.
I authorize and release the use of my image in any photograph or video recording for any purpose of
Destination Backcountry Adventures ____ (Initial here)
I HAVE READ AND UNDERSTOOD THIS DOCUMENT, AND VOLUNTARILY AND
KNOWINGLY SIGN IT.
_________________________________
Participant Signature
_____________________________ _________
Printed Name
Date
_____________________________
__________________________ _________
Printed Name
Date
Parent Signature(for minor participant)
Destination Backcountry Adventures LLC
557 6th Ave, Suite #3R, Brooklyn, NY 11215
www.destinationbackcountryadventures.com
718.208.9878