ASSUMPTION OF RISK/LIABILITY RELEASE FORM
PLEASE READ CAREFULLY AND FILL OUT COMPLETELY
Updated on March 1st 2022
(The information in this section MUST be printed legibly)
I am aware that by signing this document for participation in Big Orange Jeep Tours and Rentals, LLC activities I acknowledge that certain elements of this activity may be physically and emotionally demanding as well as dangerous. Furthermore, I understand that certain risks and dangers such as those listed below exist in the activity in which I am participating. I freely and willingly accept those risks and dangers individually and on behalf of my participating family members. These risks include, but are not limited to: loss or damage to personal property; SERIOUS INJURY OR DEATH due to inclement weather, slipping, collisions, insect bites, falling objects, falls from vehicles, vehicular accidents, vehicle malfunctions, high altitude sickness, or suffering any type of accident or illness in remote areas without easy access to medical facilities; or while traveling to and from the activity site. Full prices will be charged regardless of trip outcome.
MEDICAL INFORMATION (You are not required to provide this information but the consequences of failure to do so are solely your responsibility. Information is strictly confidential.) Please identify all known allergies to food, drugs, insect bites, etc., and the nature of the reaction. Identify and describe any disabilities or conditions that might limit your participation or place you in any heightened danger from any of the risks listed above. List any medication you are currently taking and the reason for its use:
In case of emergency, we will contact: Name: _____________________________
Relationship:____________________________________________________ Phone: (______)________________________________________________
I agree to exercise all necessary caution during any instruction and on any trip and to obey the safety requirements of those assisting me. I also agree to inform Big Orange Jeep Tours and Rentals, LLC, the guides and instructors of any significant aspects of my physical condition or medical history that might increase the risk to myself or others. I understand that I will cover any costs or other liabilities I may incur during the jeep tour adventure, and I agree to be responsible for any equipment loss or breakage due to my negligence or inattention. I understand and assume, individually and on behalf of my participating family members, all the dangers and risks associated with this activity and WAIVE ALL CLAIMS OR CAUSES OF ACTION ARISING OUT OF PARTICIPATION IN BIG ORANGE JEEP TOURS AND RENTALS, LLC, ACTIVITIES AND IN ANY WAY ARISING OUT OF, OR IN CONNECTION WITH MY TRIP, AND RELEASE ALL PERSONS AND AGENTS FROM LIABILITY WHETHER CAUSED BY BIG ORANGE JEEP TOURS AND RENTALS, LLC NEGLIGENCE, NEGLIGENCE PER SE, BREACH OF CONTRACT, WARRANTY, STRICT LIABILITY OR OTHERWISE, which I may ever have against Big Orange Jeep Tours and Rentals, LLC, its successors and assigns, its officers, directors, shareholders, employee agents, subcontractors, and their heirs, executors and assigns. I agree to release the City of Page, Az BLM and Glen Canyon National Recreation Areas from the above liabilities as stated herein associated with the use of City and County property during off-road related activities. I also authorize the use of any photographs or video recordings taken of my participation for promotional purposes. This agreement and any claims shall be governed by Arizona and Utah law.
PARENT/GUARDIAN WAIVER FOR MINORS In the event that the participant is under the age of consent (18 years of age) , then this release must be signed by a partner or guardian as follows: I hereby certify that I am the parent or legal guardian of___________________________________________________________ named above, and do hereby give my consent without reservation to the foregoing on behalf of this individual. Parent/Guardian Name:
Relationship to minor:______________________________________________ Signature:____________________________________________________________ Date:_____________