Risk acceptance waiver

ACKNOWLEDGEMENT AND ASSUMPTION OF RISK

1) Risks inherent to the activity

I recognize having been informed of the inherent risks involved with activities offered by Vélo Fjord (9439-4087 Québec inc.).

The risks inherent to the activity in which I will participate are, in particular, but not limited to:

• Injuries due to falls or other movements, (sprain, strain, fracture, etc.);

• Injuries with blunt or sharp object (branches, material, etc.);

• Cold or hypothermia, heat related problems (heat stroke, sunburn);

• Injuries resulting from accidental or other contact between individuals;

2) HEALTH PROFILE

If you have any physical, emotional or behavioural health problems that could directly or indirectly limit your participation in your chosen activity, you mush inform the Vélo Fjord staff. ex. Respiratory and/or cardiac problems, diabetes, vision or hearing problems, fear(s), limitation of movements, taking medication, allergies, pregnancy, etc.. If you have a health issue, after having discussed my medical condition with a Vélo Fjord staff member, I agree and accept the additional risk that my state of health may present, and which may be affected by participating in the activity.

3) CONFIRMATION OF INFORMATION AND ASSUMPTION OF RISKS

I hereby certify that the information consigned to this Registration Card is, to the best of my knowledge, exact and accurate. I further certify that no information pertinent or not to my health profile was deliberately omitted. I am aware that the information contained in this Registration Card is confidential and will be used to better plan and supervise the safety of the activities in which I will participate and will allow Vélo Fjord to draw up a profile of its clientele. I am also aware that the activities offered by Vélo Fjord take place in semi-wild or natural environments that, consequently, are quite distant from medical services. This state of affairs could result in long delays during an emergency requiring an evacuation and, as such, a possible aggravation of my state of health or my injury. Having taken cognizance of these risks and having had the opportunity to discuss them with a person responsible for the activity, I acknowledge that I was informed about the risks inherent to the activities and I am able to participate in the activity WILLINGLY AND I ACCEPT ANY AND ALL RISKS that such an activity or stay can comprise. I also pledge to play an active role in risk management by adopting a preventive behaviour with regards to my own safety, and the safety of the other persons that surround me. The staff reserves the right to exclude any person he/she deems to be a risk to himself/herself or to the rest of the group. I understand that I may leave the present activity for any reason whatsoever.

4) DRUGS AND ALCOHOL

I promise to not consume, have in my possession, or be under the influence of any drugs (prescription or otherwise) or illegal substances which are not mentioned in point 2 of this form.   I also confirm to not be under the influence of alcohol  (below the limit of 80 mg alcohol per 100 ml of blood, commonly called “point zero eight"), and will remain so for the entire duration activity. I am aware that any violation of these rules on my part might lead to expulsion from the activity without notice and without refund.

5) MATERIAL LIABILITY WAIVER

I, undersigned, forego any claim for damages, or legal action related to these damages, to assets and material of my belonging (attrition, loss, breakage, theft, vandalism).

6) AUTHORIZATION IN CASE OF EMERGENCY

I, undersigned, authorize ___Vélo Fjord_____ to provide all necessary care. I also authorize ___Vélo Fjord_____ to make a decision, in case of an accident, to transport me (by ambulance, helicopter, coast guard or other) to a hospital or health care center, and this, at my own expense.