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Participant Form

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Please update the following information:
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Military Information

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Health Information

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Insurance Waiver and Media Release

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Adaptive Sports Partners of the North Country is a non-commercial, not for profit activity provider. The purpose of this agreement is to exempt, waive and relieve Released Parties from any and all liability for wrongful death, personal injury, and property damage, including, but not limited to, liability arising from the negligence of Released Parties. “Released Parties” include Adaptive Sports Partners of the North Country and their representatives, administrators, directors, agents, coaches, employees, and volunteers; other participants, sponsoring agencies, sponsors, and advertisers; and, if applicable, the owners, operators, and lessors of premises on which the activities or events take place. 

In consideration of the undersigned Participant being allowed to participate in any way in Adaptive Sports Partners of the North Country related events and activities, the Undersigned (“Undersigned” means the Participant or the Participant’s parent, legal guardian, or legal representative when the Participant is under the age of 18 or legally incapacitated) agrees and acknowledges as follows: 

  1. Risks of Activity. Participant will be taking part in activities that can be hazardous and involve the risk of physical injury and/or death. The activities are inherently dangerous and Undersigned fully realizes the dangers of participating in the activities. The dangers and risks of the activities include, but are not limited to the condition of the premises and equipment, and the acts, omissions, representations, carelessness, and negligence of the Released Parties. Recognizing the risks and dangers, the Undersigned voluntarily chooses for Participant to participate in the activities and expressly assumes all risks and dangers of the participation in the activity, whether or not described above, known or unknown, inherent, or otherwise. 

  1. Release and Indemnification. Undersigned (a) unconditionally releases, forever discharges, and agrees not to sue the Released  Parties for any claims or causes of action for any liability or loss of any nature, including personal injury, death, and property damage, arising out of or relating to Participant’s participation in the activities, including, but not limited to claims of negligence, breach of warranty, and/or breach of contract the Undersigned may or will have against the Released Parties; and (b) agrees to indemnify, defend, and hold harmless the Released Parties from and against any liability or damage of any kind and from any suits, claims or demands, including legal  fees.  

  1. .Helmet Use. Undersigned agrees that Participant shall use a helmet when participating in the following activities: Alpine skiing, snowboarding, cycling, ice hockey, outdoor rock climbing, white water river-rafting, and any other activity when directed by Released Parties. Undersigned understands that a helmet is in no way a guarantee of safety and that no helmet can protect the wearer against all foreseeable impacts to the head, and that the activities can expose the Participant to forces that exceed the limits of protection provided by a helmet. Undersigned agrees to assume full responsibility for complying with this paragraph and that Released Parties shall not be liable for any injury or damages resulting from Participant’s failure to use a helmet. 

  1. Miscellaneous.  Undersigned agrees (a) Participant will not engage in any activities prohibited by any applicable laws, statutes, regulations and ordinances; (b) this agreement shall be governed by the laws of the State of NH and the exclusive jurisdiction and venue for any claim shall be located in the state courts located in Grafton County, NH; and (c) this agreement shall be binding upon the distributors, heirs, next of kin, executors, and personal representatives of the Undersigned. 

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I HAVE READ THE LIABILITY WAIVER AND RELEASE, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, HAVE NOT CHANGED IT ORALLY, AND SIGN IT VOLUNTARILY.
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MEDIA/PHOTO WAIVER: Undersigned authorizes and gives full consent to Released Parties to copyright and/or publish for public view any and all photographs, digital recordings, videotapes and/or film in which Participant appears. Undersigned agrees that Released Parties may transfer, use, or cause to be used, these digital recordings, photographs, videotapes, or films for any exhibitions, public displays, publications, commercials, art and advertising purposes, television programs, and internet without limitations or reservations
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Concussion Form

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Click here to download and read the Concussion Form

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Cancellation Policy

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Please give us as much advance notice as possible if you do need to cancel.  If you do not call or email in enough time for us to adjust our schedule (at least 30 minutes prior to the program’s start) you will be charged the greater amount of $25 and the activity fee.  If a participant is a no show twice in a season for an activity, he/she may be pulled from that activity for the remainder of the season.  Participants that take part in our Partners in Possibilities program who are no shows twice will be pulled from participating in that waived fee program for the remainder of the season. 

NOTE:  On any day, the Program Director or Volunteer Leader has the right to cancel any session if, in their opinion, the weather would create an unreasonable risk.  We will notify all participants as soon as this call is made.  Participants will not be charged if we cancel the activity. 

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Activity Information

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Please look at our Calendar to see our current activities.  If our days don't work for you, please tell us what days you were hoping to participate.

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Personal Goals for ASPNC Activity Participation

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In order for us to demonstrate progress and to help participants, care providers and families understand the real value of our programs, we would like to identify and follow four individually chosen goals. We will use the goals to help structure and individualize each activity session. After each session, volunteers make a quick summary of the activity, document breakthrough moments and reflect on the participant’s progress towards their chosen goals. Please look through the following list of goals and choose four goals pertinent to you or the person in your care. Consider choosing goals from various categories. You are welcome to add additional personal goals that might not appear on this list.
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Please choose no more than 4 goals from the following list:

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