Note: receipt of payment will confirm your place in the class. ... In consideration of
the right to participate in the Basic Mountaineering course, I release any and ...
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Basic Mountaineering Registration Form Please complete this form, along with the Liability Release and Emergency Information forms, and send along with a payment for the amount due to: The Obsidians, c/o Sue Hutchinson Carey, 3560 Glen Oak Drive, Eugene OR 97405 Note: receipt of payment will confirm your place in the class. Enrollment is limited! Age Category: Name:
Adult ___
Address:
Email:
16318___
Under 16___
Phone: Are you a member of the Obsidians?
Yes___
No___
Are you a member of Eugene Mountain Rescue?
Yes___
No___
Payment Enclosed:
$60.00 _____
(Obsidians and EMR members)
$90.00 _____
(Non3Members)
Please briefly describe any previous climbing experience you have:
We have some equipment available for loan (at no additional charge) for this course. Please indicate if you have any of the following personal climbing equipment:
Climbing helmet Harness Locking carabiners Regular (non3locking) carabiners Ice axe Belay device (e.g. ATC)
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Basic Mountaineering Sponsored By The Obsidians and Eugene Mountain Rescue Mountaineering is a sport that by nature exposes climbing parties to many hazards, only some of which can be controlled by the participants. It is important to recognize that you are about to participate in an activity which presents hazards which are different from those found in everyday life. While it is impossible to eliminate all risks, you can increase your margin of safety and minimize risks by paying close attention to safety rules and procedures presented during this class. Mountaineering may expose you to environmental hazards such as thunderstorms, extreme cold, snow, strong winds, and rockfall. While climbing, you may be exposed to vertical drops, steep slopes, and crevasses. The skills you will learn in this class will help you to deal with these hazards but they can not prevent their occurrence. The volunteers from Eugene Mountain Rescue and the Obsidians who are leading this class are skilled in the techniques they are teaching. Nevertheless, they can not be everywhere at once, nor are they able to guarantee your total protection from accidents or injuries. We encourage you to develop a questioning attitude and hope that you will ask our leaders to explain any action, direction, or procedure which makes you uncomfortable or that you do not completely understand. The primary goal of this class is to give you the skills to take care of yourself in mountaineering situations while participating with more experienced leaders. We hope the skills you learn will help you participate in a safe manner and enhance your enjoyment of the alpine environment.
Release from Liability Agreement In consideration of the right to participate in the Basic Mountaineering course, I release any and all claims against the Obsidians and Eugene Mountain Rescue, and their volunteers for damages and losses suffered by me or my minor child as a result of said participation. I further understand that there are certain risks inherent in this activity and that proper training and physical conditioning is necessary. I hereby agree to assume these risks on my behalf or on behalf of my minor child and to hold harmless the Obsidians, Eugene Mountain Rescue, and the members of these organizations. I have read and understood the above. Name: Signature:
Date: (Parent or guardian must sign if participant is under 18)
Please fill out the following health and emergency information. This information will be kept confidential and referred to only in the case of an emergency. Health Information Emergency Contact Information: Your Name: Emergency Contact Info:
(Name)
(Address)
(City)
(Name)
(Address)
(state)
(Phone)
Physician (Phone)
Health and Accident Insurance is your responsibility. We recommend that you obtain appropriate insurance. Describe any illness or injury, current or past, that might affect your ability to participate fully and safely in this course, including but not limited to: back or knee problems, cardiac or respiratory ailments, diabetes, allergies, migraines, sensitivity to cold, or seizure disorders.
List any drugs or medications you are currently taking that may affect your ability to participate or are related to management of the conditions described above:
