REQUIRED REGISTRATION FORMS - EXPLORE ROTCSUBMIT THESE FORMS TO OUR OFFICE BY MAIL OR EMAIL WITHIN 14 DAYS OF REGISTRATION

I understand that, during my participation on an Adventure WV program, I will be exposed to above normal risks. Although Adventure WV has taken precautions to provide proper organization, supervision, instruction and equipment for each trip, it is impossible for the Adventure WV program to guarantee absolute safety. I acknowledge that all risks cannot be eliminated without destroying the purpose and character of the trip or seminar. Also, I understand that I share the responsibility for safety on the trip and I assume that responsibility. I agree to comply with the instructions and directions of the Adventure WV staff members during the trip. The following describes some, but not all of the risks:

• WVU Adventure WV programs take place out of doors, where participants are subject to environmental and other risks. Activitiesinclude hiking and backpacking, camping, rock climbing, initiatives, challenge course, zip line, caving, and whitewater boating.

• Activities take place in remote places, far from medical facilities. Communication and transportation are difficult and sometimesevacuations and medical care can be significantly delayed.

• Equipment may fail or malfunction, despite reasonable maintenance and use. Meals are prepared on gas stoves or fires. Waterrequires disinfection before use. Camping risks and hazards include burns, cuts, diarrhea and flu-like illness, and falling timber.

• Travel is by vehicle, raft, on foot and by other means, over rugged unpredictable off-trail terrain, including boulder fields, downedtimber, rivers, rapids, river crossings, mountain passes, steep slopes, slippery rocks. Risks include collision, falling, capsizing,drowning and others usually associated with such travel.

• Environmental risks and hazards include rapidly moving, deep or cold water; insects, snakes, and predators, including largeanimals; falling and rolling rock; lightning, flash floods, and unpredictable forces of nature, including weather which may change toextreme conditions without notice. Possible injuries and illnesses include hypothermia, frostbite, sunburn, heatstroke,dehydration, and other mild or serious conditions.

I am aware that Adventure WV activities include risks of my injury or death. I understand the description above of these risks is not complete and that other unknown or unanticipated risks may result in property loss, injury or death. I agree to assume responsibility for the inherent risks identified herein and those inherent risks not specifically identified. My participation in this activity is purely voluntary, no one is forcing me to participate, and I elect to participant in spite of and with knowledge of the inherent risks.

I have no physical or psychological problems that would prohibit my participation in the trip. I further understand that West Virginia University will not provide medical or other insurance coverage for this trip. If I must evacuate for any reason, I understand I am personally responsible for all medical/evacuation fees and that I will not receive a refund of the trip fee. (Participant must provide a copy of their medical insurance card prior to participation).

In consideration for the opportunity to participate in the activity and to the extent allowed by law, I release West Virginia University and its employees, agents, and volunteers, and waive all claims for personal injury or any other damage which may arise out of or be in any way related to my participation in this activity, including any claim based on actual or alleged negligence, gross negligence, intentional, or reckless behavior.

Participant’s Name (Please Print):

Student Signature: Date:

I (we) acknowledge that there can be no guarantee of absolute safety against risks and unforeseen accident, as detailed above, that West Virginia University will not provide medical or other insurance coverage for this trip, and consent to the participation of the above named individual with the Adventure WV program.

Parent/Guardian Name (If participant is under 18 yrs of age - Please print):

Parent/Guardian Signature: Date:

Phone (304) 293-5221 – AdventureWV@mail.wvu.edu – adventurewv.wvu.edu 2001 Rec Center Dr., Morgantown, WV 26506-6018

ADVENTURE WV – WEST VIRGINIA UNIVERSITY ACKNOWLEDGEMENT OF RISK AND ASSUMPTION OF RESPONSIBILITY

REQUIRED REGISTRATION FORMS - EXPLORE ROTC SUBMIT THESE FORMS TO OUR OFFICE BY MAIL OR EMAIL WITHIN 14 DAYS OF REGISTRATION

Phone (304) 293-5221 – AdventureWV@mail.wvu.edu – adventurewv.wvu.edu 2001 Rec Center Dr., Morgantown, WV 26506-6018

ADVENTURE WV – WEST VIRGINIA UNIVERSITY COMMITMENT TO EXCELLENCE & MEDIA RELEASE FORM

➢ Please write legibly and in pen.

We are excited you are participating in an Adventure WV program. We work hard to ensure that each AWV program is safe, challenging, and fun. In order to live up to these standards and to provide the best program possible, we additionally have high expectations for all of our participants. We ask you as a participant to be committed to excellence by agreeing to abide by the course conditions, in that you will:

• Be open to meeting new people, try new things, have fun, and challenge yourself

• Be willing to do your best and work hard to complete all activities on your program

• Maintain a positive attitude, even in the face of hardship and difficulties

• Comply with procedures and practices, as outlined by the AWV staff

• Respect and follow the Leave No Trace environmental practices

• Demonstrate appropriate language and behavior toward people and the environment, and leave behind alcohol,tobacco, and/or drugs (abusive behavior or the possession of these items will be cause for expulsion). This is atobacco-free program.

I have read the above information and agree to abide by the rules and standards of Adventure WV programs.

Student Signature: ___________________________________________________ Date: __________________________

COMMITMENT TO EXCELLENCE

For the privilege of participating in activities for West Virginia University, I hereby give my consent for my image andlikeness to be videotaped, audiotaped, or photographed for the following uses:

• Educational/instructional media• Recruitment/outreach media• Development media• Newsworthy media documentation

I further authorize West Virginia University and/or West Virginia University Hospitals, Inc., and their component parts, touse this electronic media and/or photographs in any manner—whole, or in part.

This waiver includes usage of this media in any way deemed appropriate, which may include electronic andphotographical reproductions thereof for the production of educational, instructional, promotional, or institutionaladvancement materials which support the educational and outreach activities of West Virginia University.

I hereby waive any right I may have to inspect or approve any use of this electronic media and/or photographs and Irelease West Virginia University and its component parts from all liability which could result from its use.

Participant’s Name: __________________________________________________________________________________

Student Signature: ___________________________________________________ Date: __________________________

A parent or guardian must sign this form if the model is a minor or if the model is hindered by mental or physical challenges.

Parent/Guardian Name: _______________________________________________________________________________

Parent/Guardian Signature: ____________________________________________ Date: __________________________

MEDIA RECORDING/USAGE RELEASE

➢ Please write legibly and in pen.➢ Please answer the following questions honestly and accurately. This information will be kept confidential.➢ Our goal is to provide you with the best experience possible, making accommodations where needed.➢ Please contact us for questions or concerns about any of the following items.➢ *Please notify us of any changes that happen between completing this form and the start of your program.*

Last Name: _____________________________________ First Name: ____________________________________

WVU ID#: _________________________ Mix Email: ___________________________________________________

Home Phone: __________________________________________ Cell Phone: ______________________________

Height: ____________ Weight: ___________ Gender: ______________ Date of Birth: ______/______/________

Age: ______________ Dorm Name & Room # (if applicable): ____________________

Street Address _________________________________________ City/State/Zip: ___________________________

PARTICIPANT INFORMATION

Emergency Contact #1: __________________________________________ Relationship: _____________________

Cell Phone: ________________ Home: ________________ Work: ________________ Email: _________________

Emergency Contact #2: __________________________________________ Relationship: _____________________

Cell Phone: ________________ Home: ________________ Work: ________________ Email: _________________

EMERGENCY CONTACT INFORMATION

Each participant is responsible for medical expenses. A copy of your current medical insurance card should be brought along with you on the program.

Name of Insurance Company: _____________________________ Insurance Co. Phone: ______________________

Group #: ______________________________________________ Name on Insurance Card: ___________________

INSURANCE INFORMATION

Do you have any ALLERGIES? ____ YES ____ NO

If YES, do you carry epinephrine, such as an Epi-Pen? ____ YES ____ NO

If YES, Have you ever been hospitalized for these allergies? ____ YES ____ NO

Describe your allergies, including severity and other pertinent information: __________________________________

_______________________________________________________________________________________________

_______________________________________________________________________________________________

ALLERGY INFORMATION

ADVENTURE WV – WEST VIRGINIA UNIVERSITY Participant Information Form

REQUIRED REGISTRATION FORMS - EXPLORE ROTC SUBMIT THESE FORMS TO OUR OFFICE BY MAIL OR EMAIL WITHIN 14 DAYS OF REGISTRATION

Phone (304) 293-5221 – AdventureWV@mail.wvu.edu – adventurewv.wvu.edu 2001 Rec Center Dr., Morgantown, WV 26506-6018

Please mark dietary restrictions, needs, and requests here. If it is not listed on this form, we cannot accommodate it.

Do you have any DIETARY RESTRICTIONS (i.e. vegetarian, lactose-intolerant, etc.)? ____ YES ____ NO

Describe your dietary restrictions, including foods avoided and other pertinent information: ____________________

_______________________________________________________________________________________________

DIETARY INFORMATION

Please list any other pertinent health information that may affect your ability to participate in this program, including recent injuries, pre-existing health conditions, etc. It is also helpful for us to know if you have or are planning on requesting accommodations from WVU Office of Accessibility Services that may also apply to your program: _______________________________________________________________________________________

_______________________________________________________________________________________________

OTHER PERTINENT HEALTH INFORMATION

If you are taking any medication that may be required during the program, you must bring all of those with you. If you do not have them, you may not be allowed to participate in the program. Please list all medications, if not taken, that may affect your ability to participate in the program: ________________

_______________________________________________________________________________________________

MEDICATIONS

If you regularly use any brace, orthotic, or other device, please bring this device with you. If you do not have them, you may not be allowed to participate in the program.

Please list any brace, orthotic, or other device that you use regularly: ______________________________________

_______________________________________________________________________________________________

OTHER

Please bring any vision or hearing corrective items with you. If you wear contacts, please bring glasses in addition.

Do you wear glasses, contacts, hearing aids, or use other implements to correct vision/hearing? ____YES ____NO

VISION/HEARING CORRECTION

Physician’s Name: ____________________________________________ Phone: ____________________________

PHYSICIAN INFORMATION

I have reviewed the AWV Essential Eligibility Criteria online at adventurefirstyear.wvu.edu/essential-eligibility-criteria and certify that I meet the criteria necessary to participate in the activities involved: ____________________ (initial)

I hereby state, to the best of my knowledge, my answers to the questions on this form are complete and correct.

Signature of Participant: ____________________________________________________ Date: _________________

Signature of Parent/Guardian (Required if under 18): _____________________________ Date: ________________

ACCURACY STATEMENT

REQUIRED REGISTRATION FORMS - EXPLORE ROTC SUBMIT THESE FORMS TO OUR OFFICE BY MAIL OR EMAIL WITHIN 14 DAYS OF REGISTRATION

Phone (304) 293-5221 – AdventureWV@mail.wvu.edu – adventurewv.wvu.edu 2001 Rec Center Dr., Morgantown, WV 26506-6018

Note that the following two pages contain a third-party

waiver for the whitewater rafting that is an activity on your

Explore ROTC trip. It is the “Release, Assumption of Risk and Indemnity Agreement” for River Expeditions – the company

which guides the rafting.

o You must print, complete, and return BOTH pages of this

waiver to Adventure WV First-Year Trips.

o PAGE 1:

▪ If you will be 18 years old by the time of your trip, you

only need to sign next to the “Adult Signature”. If you will

NOT be 18 years old by the time of your trip, you must

sign next to the “Minor’s Signature” and you must ALSO

have a parent or legal guardian sign next to

“Parent/Legal Guardian Signature”.

o PAGE 2:

▪ You only need to fill in your information for the fields

that are highlighted and circled. Providing your email

address is OPTIONAL!

RELEASE, ASSUMPTION OF RISK and INDEMNITY AGREEMENTREAD CAREFULLY

I acknowledge that, directly or indirectly, I have requested that I or the minor identified below be allowed to participate in certain activities and be allowed to utilize certain services provided by Extreme Expeditions of West Virginia, Inc.; Rivers; Appalachian Wildwaters; USA Raft; and/or River Expeditions, Inc., and they and any commonly owned, related, parent or subsidiary corporations and entities, their owners, officers, directors, agents, and employees, whether or not separately identified herein, and/or any successor and/or assignee, are hereafter collectively referred to as “Outfitter.”

I acknowledge that, whether or not I or the minor identified below participate in any whitewater rafting activities, the Outfitter may have been requested to arrange for or allow me or the minor identified below to participate in other activities or use services provided by the Outfitter or by other persons, businesses, or entities, including but not limited to helicopter sightseeing tours, biking activities, rock climbing & rappelling, horseback riding, ATV tours, canopy and zip line tours, and/or paint ball games and activities, camping or use of cabins, the swimming pool and/or hot tub, providers of food, beer, or other products, and acknowledge that Outfitter has made no representation whatsoever as to the safety or quality of those activities or services but has only made arrangements for me or the minor to participate in those activities or use those services as an accommodation to me at my request.

I understand that I am about to engage in activities that pose substantial risks of physical injury and/or death, disease or illness and/or damage to or loss of personal property as the result of exposure; travel over and through rough terrain and on public or private roads; traveling on turbulent and cold whitewater rivers and streams in rafts, kayaks, duckies, or other floatation devices; jumping, diving, or being thrown into the water; striking rocks and other obstructions or encountering standing waves or turbulent waters; the use of paddles, oars and other equipment; other unnamed but foreseeable risks related to whitewater activities; injuries by insects, animals or reptiles; the lack of adequate medical facilities in remote areas; travel by air, train, automobile, truck, bus, horse, bicycle, ATV, and/or other conveyance while traveling to or from an activity site or participating in an activity; camping out and using primitive facilities; the negligence, gross negligence, and/or bad judgment of the Outfitter, other providers and/or other participants; and defects in equipment or products. I understand that I am subject to even greater risk on and about the Gauley River because of higher water flow, steeper gradient (greater drop per mile), inaccessible locations, and the difficult and dangerous surrounding terrain or in Wildside and/or Extreme Wildside rafting activities because of the smaller rafts used and the more hazardous whitewater conditions undertaken. I represent that I am in good physical condition and health and am able to safely participate in the activities in which I have requested to be allowed to do so.

In consideration of and as part payment for my right or that of the minor identified below to participate in such activities and utilize such services, I PERSONALLY do hereby, to the greatest extent permitted by law, ASSUME all of the reasonably related and foreseeable risks, whether or not specifically identified herein, of all the activities and services in which either of us participate or which either of us use; RELEASE the Outfitter from any and all liability, including but not limited to liability arising from negligence, gross negligence and/or willful and wanton conduct; and, will INDEMNIFY and hold the Outfitter harmless from any and all liability, claims, and demands of every kind and nature whatsoever which I or the minor identified below may ever have arising, directly or indirectly, from participation in any and all such activities or using such services, including Outfitter’s defense costs and expenses and/or the cost of any medical or other expenses incurred for my or such minor’s benefit.

I consent to the use by the Outfitter of photographs and video recordings made of me or the minor identified below while participatingin such activities or using such services without further compensation and agree that all such materials including negatives, are the sole property of the Outfitter.

I agree that the exclusive venue of any suit or claim against the Outfitter for any reason whatsoever shall be the Magistrate or Circuit Courts of Fayette County, West Virginia; consent to the jurisdiction of such Courts as to any action against me to enforce this Agreement; agree that this Agreement is to be enforced in accordance with the law of the State of West Virginia; and agree that if any part of this Agreement is found to be invalid that all other portions shall be fully enforceable.

Adult Signature X______________________________________________________________ Date _______________________________

FOR PARTICIPANTS UNDER THE AGE OF 18I, the minor whose name appears below, have read or had my parent or legal guardian read this Agreement on both sides of this document and agree to all of the terms and conditions:

Minor’s Signature X___________________________________________________________ Date of Birth _________________________

PARENT/LEGAL GUARDIAN PERMISSION FOR MINOR TO PARTICIPATE:Having legal authority to do so, I give the above minor permission to participate in the activities offered by or arranged through the Outfitter, give the Outfitter permission to provide medical treatment or authorize such treatment in case of emergency or accident; and, will indemnify and hold harmless the Outfitter as stated in this document for any legal claims made by or on behalf of the said minor.

Parent/Legal Guardian Signature X___________________________________________________ Date ___________________________(Relationship to Minor)________________________________________________________________

SEE THE REVERSE SIDE OF THIS DOCUMENT

READ CAREFULLY

THE WEST VIRGINIA WHITEWATER RESPONSIBILITY ACTDUTIES OF A PARTICIPANT(West Virgina Code 20-3B-5)

(a) Participants have a duty to act as would a reasonably prudent person when engaging in recreationalactivities offered by commercial whitewater outfitters and commercial whitewater guides in thisstate.

(b) No participant may:

(1) Board upon or embark upon any commercial whitewater expedition when intoxicated or underthe influence of nonintoxicating beer, intoxicating beverages or controlled substances; or

(2) Fail to advise the trip leader or the trip guide of any known health problems or medical disabilityand any prescribed medication that may be used in the treatment of such health problems duringthe course of the commercial whitewater expedition; or

(3) Engage in harmful conduct or willfully or negligently engage in any type of conduct whichcontributes to or causes injury to any person or property; or

(4) Perform any act which interferes with the safe running and operation of the expedition, includingfailure to follow the instructions of the trip leader or trip guide in regard to the safety measuresand conduct requested of the participants; or

(5) Fail to inform or notify the trip guide or trip leader of any incident or accident involving personalinjury or illness experienced during the course of any commercial whitewater expedition. If suchinjury or illness occurs, the participant shall leave personal identification, including name andaddress, with the commercial whitewater outfitter ’s agent or employee.

Initials _____________

Person’s Name Your Reservation is Under _________________________________________________________________________

Trip Date Number of People in Your Group

New 1-Day Upper Weekday

Gauley 2-Day Lower Weekend

3-Day Whole

Date of Birth

Last Name First Name

Present Address

City State

Zip

Home Phone Have you rafted before?: Yes NoIf yes, with which company____________________

e-mail Address

By providing your email address, you hereby authorize the Outfitter to contact you via this medium.

Adventure West Virginia - WVU