SMG Release

Save time by filling out our release form ahead of your course or climb. Please contact us if you have any questions or problems. Photo: cliffs, including the Eaglet, in Franconia Notch, New Hampshire.

PARTICIPANT RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT | ***READ BEFORE SIGNING***
Synnott Mountain Guides LLC | PO Box 72 | Jackson, NH 03846
Participant Name*
First Last
Participant Email*
Enter Email Confirm Email
Participant Phone*
Cell phone preferable.
Participant Mailing Address*
Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Emergency Contact Name*
First Last
Emergency Contact Phone*
Cell phone preferable.
Booking Info*
So that we can apply this release to the correct booking, please provide basic details including the date(s), course, and booking name (if different than participant name).
In consideration of being allowed to participate in any way in the program, related events and activities, I the undersigned, acknowledge, appreciate, and agree that:
1. The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death.

2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation.

3. I willingly agree to comply with terms and conditions for participation. If I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately.

4. I understand there are risks of contracting infectious diseases which can be reduced but not eliminated, and mitigation efforts require the understanding and cooperation of everyone participating in an activity with SMG. I have chosen to voluntarily participate in the activity and I assume the risk of contracting an infectious disease. While participating, I agree to follow current recommendations offered by the Centers for Disease Control and/or any restrictions imposed by federal, state, or local authorities.

5. By participating in or attending any activity in connection with this program, whether on or off the premises, I consent to the use of any photographs, pictures, film or videotape taken of me or provided by me for publicity, promotion, television, websites or any other use, and expressly waive any right of privacy, compensation, copyright or other ownership right connected to same.

6. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS Mark Synnott and/or Synnott Mountain Guides LLC, its officers, officials, agents and/or employees, other participants, sponsors, advertisers, and, if applicable, owners and lessors of premises used to conduct the event (RELEASEES), from any and all claims, demands, losses, and liability arising out of or related to any INJURY, DISABILITY OR DEATH I may suffer, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
Participant's Signature*
Participant's Age*
Please enter a number from 1 to 120.
Date*
MM slash DD slash YYYY
FOR PARENTS/GUARDIANS OF PARTICIPANT OF MINOR AGE (UNDER AGE 18 AT TIME OF REGISTRATION)
This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liability incidents to my minor child’s involvement or participation in these programs as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by law.
Parent/Guardian Name*
First Last
Parent/Guardian Signature*
Date*
MM slash DD slash YYYY
Email
This field is for validation purposes and should be left unchanged.

SMG Release

Contact

AMGA/IFMGA Mountain Guide Mark Synnott

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