Wilderness Ready: Participant Agreement, Medical Information and Release
A ministry of Nieto Ministries. One form per participant. Participants under 18 must have a parent or legal guardian sign.
1. Participant
Participant full name
Date of birth (must be 14 or older)
Club, church or group
Program / dates
2. Medical and allergy information
Allergies (food, plant, insect sting, medication)
Medications carried (e.g. epinephrine auto-injector, inhaler)
Medical conditions we should know about
Dietary restrictions
Emergency contact name and relationship
Emergency contact phone
3. I understand and agree
- Wilderness activities carry real risks, including uneven terrain, weather, water, fire, insects and wildlife, knives and tools, and distance from medical care.
- I will follow the instructor's directions and the safety rules, use the buddy system, and not leave the group without permission.
- Wild plants: I will only taste plants the instructor has positively identified, and I may decline at any time.
- Water is treated before drinking; fires are only built where and when the instructor allows.
- Snares and traps are demonstrations only; no animals are trapped.
- The instructor may arrange emergency medical care for the participant if needed, and I accept responsibility for its cost.
- Photos may be taken during class for ministry use. [ ] Check here to opt out.
- I release Nieto Ministries, its instructors and volunteers from claims arising from ordinary negligence to the extent allowed by law.
4. Signatures
Participant signature
Date
Parent or guardian signature (if under 18)
Printed name and date
Red Cross course participants may also complete American Red Cross forms.