REQUIRED REGISTRATION FORMS TRANSFER TRIP SUBMIT THESE FORMS TO OUR OFFICE BY MAIL, FAX, OR WITHIN 14 DAYS OF REGISTRATION

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1 REQUIRED REGISTRATION FORMS TRANSFER TRIP SUBMIT THESE FORMS TO OUR OFFICE BY MAIL, FAX, OR 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. Activities include 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 sometimes evacuations 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. Water requires 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, downed timber, 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 large animals; falling and rolling rock; lightning, flash floods, and unpredictable forces of nature, including weather which may change to extreme 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) AdventureWV@mail.wvu.edu adventurewv.wvu.edu Fax (304) Rec Center Dr., Morgantown, WV

2 Please write legibly and in pen. COMMITMENT TO EXCELLENCE SUBMIT THIS FORM TO OUR OFFICE BY MAIL, FAX, OR ADVENTURE WV WEST VIRGINIA UNIVERSITY COMMITMENT TO EXCELLENCE & MEDIA RELEASE FORM 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 a tobacco-free program. I have read the above information and agree to abide by the rules and standards of Adventure WV programs. Student Signature: Date: MEDIA RECORDING/USAGE RELEASE For the privilege of participating in activities for West Virginia University, I hereby give my consent for my image and likeness 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, to use 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 and photographical reproductions thereof for the production of educational, instructional, promotional, or institutional advancement 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 I release 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: Phone (304) AdventureWV@mail.wvu.edu adventurewv.wvu.edu Fax (304) Rec Center Dr., Morgantown, WV

3 SUBMIT THIS FORM TO OUR OFFICE BY MAIL, FAX, OR ADVENTURE WV WEST VIRGINIA UNIVERSITY Participant Information Form Program Name: FIRST YEAR TRIPS ONLY: Trip Model & #: 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.* PARTICIPANT INFORMATION Last Name: First Name: WVU ID#: Height: Weight: Gender: Date of Birth: / / Age: Dorm Name & Room #: Street Address: City/State/Zip: Home Phone: Cell Phone: How did you hear about Adventure WV? EMERGENCY CONTACT INFORMATION Emergency Contact #1: Relationship: Cell Phone: Home: Work: Emergency Contact #2: Relationship: Cell Phone: Home: Work: INSURANCE 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: ALLERGY 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: Phone (304) AdventureWV@mail.wvu.edu adventurewv.wvu.edu Fax (304) Rec Center Dr., Morgantown, WV Page 1 of 2

4 SUBMIT THIS FORM TO OUR OFFICE BY MAIL, FAX, OR DIETARY INFORMATION 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: OTHER PERTINENT HEALTH 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.: MEDICATIONS 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: OTHER 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: VISION/HEARING CORRECTION 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 PHYSICIAN INFORMATION Physician s Name: Phone: ACCURACY STATEMENT 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: Phone (304) AdventureWV@mail.wvu.edu adventurewv.wvu.edu Fax (304) Rec Center Dr., Morgantown, WV Page 2 of 2

5 Note that the following three pages contain a third-party waiver for an activity that is specific to your Wilderness WV trip. It is the Via Ferrata Climber Agreement for NRocks Outdoor Adventures. While you must read over all three pages, the ONLY page that you need to print, complete, and return to Adventure WV First-Year Trips is page 3. You must return this third-party waiver in addition to the Adventure WV specific forms that precede this page.

6 Risks Via Ferrata Climber Agreement (Including Acknowledgement of Risks and Agreements of Release and Indemnity) This document contains important information about the Via Ferrata at NROCKS Outdoor Adventures (referred to herein as NROCKS ) and the properties on which it is located. It may affect the legal rights of climbers of the Via Ferrata and their families. It must be read, understood and signed by all Climbers 18 years or older. If a Climber is a minor (under 18 years of age) his or her parent or legal guardian (referred to herein as Parent ) must sign, for himself or herself and on behalf of the minor child. In consideration of being allowed to climb the Via Ferrata and to move about its premises, the undersigned adult Climber and Parent, if applicable, acknowledge and agree as follows: The Via Ferrata The Via Ferrata is a hiking and rock climbing route with permanently fixed rungs, cables, and other climbing aids to assist in movement over the vertical rock faces. The Via Ferrata utilizes steel climbing rungs on steeper sections to decrease the difficulty of the climb. The climb is steep and arduous with approximately 900 feet of elevation gain/loss over the approximately three mile hike/climb. The hiking and climbing surfaces are loose, slippery and unstable and will require Climber to use his or her hands in order to maintain balance. At times, Climber is exposed to a potential fall of over 200 feet. The Via Ferrata includes one suspension bridge that has open spaces between the support boards and is 200 feet long and 150 feet above the ground. Climber is required to attach, un-attach and re-attach himself or herself to an accompanying cable or steel rungs by means of a double, or Y, lanyard, allowing Climber to remain attached by one leg of the lanyard while re-attaching, by means of the other leg, to a new location on the cable/rungs. The Via Ferrata requires Climber to be alert and demonstrate careful judgment and strict attention to remaining attached to the cables/rungs at all times. The Via Ferrata experience is designed for use by persons of at least average mobility, strength, physical ability, emotional stability, and in good health. Climber must carefully consider health issues physical and emotional, including the use of prescription or nonprescription medications before choosing to participate, and inform Via Ferrata staff, in writing, prior to the beginning of the experience, of any issue which might affect his or her performance on the route. Climber not Via Ferrata staff has the responsibility of determining his or her level of fitness and other qualifications, physical and emotional, to participate in the Via Ferrata experience. Climber agrees that he or she will not use, and will not be under the influence of, any recreational drug or alcohol while climbing the Via Ferrata. Climber understands that he or she must be attentive to instructions and warnings posted at the Via Ferrata registration area and provided by Via Ferrata staff during the hiking and climbing portions of the experience. Failure of Climber to abide by all rules, guidelines and instructions of Via Ferrata staff may, at the sole discretion of the staff, result in the dismissal of Climber from the Via Ferrata climb without refund of any fee or other expense paid. The risks of the Via Ferrata and hiking to and from the climbing site, include, among others, rockfall (including rocks dislodged by other climbers), slips, falls, and jolts at the end of a lanyard, causing abrupt contact with the rock face, climbing aids or other climbers. Climbing gear may fail, be misfitted or misused. Climbing aids, however permanently affixed they may appear, may fail. Climber is responsible for his or her own safety and if Climber has doubts about his or her ability to manage the risks of the adventure he or she must not climb. Via Ferrata staff cannot, and must not be expected to, be responsible for the actions of Climber. Staff members and participants may make mistakes of judgment and conduct. Climbing the Via Ferrata and hiking to and from it will expose Climber to the unpredictable forces of nature, including, but not limited to, changing weather conditions, high winds, lightning and hail. Climber may come in contact with plants and insects that create hazards, including allergic reactions, and a variety of wild animals including, but not limited to, deer, snakes, bear, bobcat, and skunks. The Via Ferrata experience occurs in a remote location where radio and telephone communication is unpredictable and medical care and evacuation may be significantly delayed. These risks are inherent in the Via Ferrata experience; that is, they cannot be eliminated without destroying the unique character of the experience. These and other risks may result in injuries and illnesses, including pinches, scrapes, twists bruises, sprains, lacerations, fractures and other physical and emotional trauma, and in extreme circumstances even death. Assumption of Risks. I, adult Climber or Parent of a minor Climber, have read and understand the information above, and have viewed images and received additional information at the registration counter and/or on the web site of the Via Ferrata, ( I understand that the above description of risks of the Via Ferrata is not complete and that these and other, including unknown or unanticipated, risks, inherent and otherwise, may result in loss or property, injury or death. If I am a Parent of a minor Climber I have

7 discussed the activities and their risks and possible outcomes with my child, and he or she wishes to participate nevertheless. I expressly and voluntarily agree to accept and assume all of the risks of enrollment and participation in the Via Ferrata experience and related activities, and moving about the premises of the experience, whether or not described above and inherent or otherwise. Release. I, adult Climber or Parent of a minor Climber (Parent, for myself and, to the fullest extent allowed by law, on behalf of my minor child), hereby voluntarily release Wild West Virginia Outdoor Adventures LLC, doing business as NROCKS Outdoor Adventures, and Fun & Dreams West LLC, and their respective owners, members, officers, directors and staff ( Released Parties ) from any and all claims, demands or causes of action, which are in any way related to my, or the minor child s, enrollment or participation in the Via Ferrata experience, including the tour, and the use of Via Ferrata equipment, vehicles, structures, and adjoining premises. This release includes claims of negligence of a Released Party and to the fullest extent allowed by the laws of West Virginia, claims of aggravated forms of negligence, and other careless or wrongful conduct of a Released Party. Indemnity. I, adult Climber or Parent of a minor Climber, agree further to indemnify (that is defend and protect, and pay or reimburse) the Released Parties and each of them from any claim, by whomever it might be brought, including the minor child, other participants and members of my, or the minor child s, family, arising from my, or the child s enrollment or participation in the Via Ferrata experience, including the tour, and the use of Via Ferrata premises, equipment, vehicles and structures. This indemnity includes losses suffered by me, or the child, and losses caused by me or the child. This indemnity includes claims of negligence of a Released Party and to the fullest extent allowed by the laws of West Virginia, claims of aggravated forms of negligence, and other careless or wrongful conduct of a Released Party. Should a Released Party or anyone acting on his or her behalf incur attorney s fees and costs to enforce this agreement or otherwise defend a claim, I agree to indemnify and hold them harmless for and pay or reimburse all such fees and costs to the extent such a claim is withdrawn or relief is not granted on the claim by a court of competent jurisdiction. Other. I, adult Climber or Parent of a minor Climber, further agree: a. I have adequate insurance to cover any injury or damage I, or the minor Climber, may cause or suffer while participating in the activities at the Via Ferrata or moving about the premises. b. In the event that I, the child or anyone on my or the child s behalf files a lawsuit files a lawsuit against a Released Party, I agree that the venue of any such suit shall be Pendleton County, West Virginia. I further agree that the substantive laws of West Virginia shall apply in the action without regard to the conflict of law rules of that state. c. I have had sufficient opportunity to read this entire document. I have read and understood it and I agree to be bound by its terms. I intend it to be binding on me, members of my family, my heirs and estate. d. I hereby authorize Wild West Virginia Outdoor Adventures LLC to utilize any photo/video or any other media containing images/sounds of myself, or of my child, for promotional or other purposes, without compensation. e. If any part of this document is deemed unenforceable by a court of competent jurisdiction, the remaining provisions will nevertheless remain in full force and effect. Wild West Virginia Outdoor Adventures LLC / NROCKS Outdoor Adventures 2 Via Ferrata Climber Agreement

8 Medical Information. I, adult Climber or Parent of a minor Climber, understand that participating in the Via Ferrata experience is a strenuous activity. Obesity, high blood pressure, cardiac and coronary artery disease, pulmonary problems, diabetes, asthma, allergies, seizure disorders, pregnancy, arthritis, tendonitis and other joint and muscular-skeletal problems, recent surgery and other medical issues physical and emotional (such as fear of heights) will increase the inherent risks of the experience and cause Climber to be a danger to himself or herself and to others. It is with this understanding that I have listed below my, or the minor Climber s, medical conditions pertinent to the Via Ferrata experience. If Climber is a female, I acknowledge that participating in the Via Ferrata is not recommended for women who are pregnant and that I am not, or the minor Climber is not, pregnant at this time. Climber, adult or minor, is taking the following medications: (If none, indicate none) Climber, adult or minor, has the following medical conditions which might affect his or her participation in the Via Ferrata climb: (If none, indicate none) I have truthfully completed the medical and special needs information called for above. NROCKS Outdoor Adventures staff is authorized to provide or obtain emergency medical care for me, or my child, and to exchange pertinent medical information with a third party medical care giver. Participant s Name (printed): Date: Adult Participant s Signature: Address: City: State: Zip: In case of emergency contact: Phone: Relation to Participant: Participant s Age (if under 18): Participant s Birth date (if under 18): If Participant is less than 18 years of age, Parent must also sign. Minor s Name (printed): Parent/Guardian Name (printed): Date: Parent/Guardian Signature: Address: City: State: Zip: Wild West Virginia Outdoor Adventures LLC / NROCKS Outdoor Adventures 3 Via Ferrata Climber Agreement