High Ropes Participation Waiver and Release Form

High Ropes Participation Waiver and Release Form

In order to participate in High Ropes and Zipline programming at Girl Scouts of Kentuckiana, the Girl Scout and a guardian must read and sign the participation waiver below. Girl Scouts without a signed waiver will not be allowed to participate.
Participant Information
In order to participate in High Ropes and Zipline programming, participants must be at least 11 years old and no more than 250 pounds.
Participant Name

First NameLast Name
Participant Birth Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Participant Height (ft, in.)
Participant Weight (lbs.)
Participant Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is this waiver for a Girl Scout or for an Adult Volunteer?
Parent/Guardian Information
Parent/Guardian Name

First NameLast Name
Relationship to Participant
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Emergency Contact Information
Is the parent/guardian also the participant's emergency contact?
If you are an adult volunteer, please select 'No, I'd like to add someone else.'
Name

First NameLast Name
Relationship to Participant
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Medical Considerations
Please list any medical considerations that program facilitators should know.
High Ropes Participation Waiver and Release Form
Please read the waiver below and complete the acknowledgement and signatures.
I acknowledge that I have read and agree to all statements outlined in the High Ropes Participation Waiver and Release Form.
Participant Signature
Parent Signature
Should be Empty:

High Ropes Participation Waiver and Release Form

Participant Information

Parent/Guardian Information

Emergency Contact Information

Medical Considerations

High Ropes Participation Waiver and Release Form