Pikes Peak Chapter / Colorado Archaeological Society
RELEASE OF LIABILITY STATEMENT
Name of Activity: __________________________________ Date(s): _________________________________
I/We understand that all activity arrangements, terms and conditions have been established in good faith and
understand that changes in the itinerary, leadership, activities, accommodations, and/or transportation may be
necessary in the best interest of all participants due to circumstances beyond the control of the organizers. I/We
understand that no matter how well planned an activity is, there may be inherent dangers and risks (known or
unknown) in conjunction with the event, relating—but not limited to—land, water, illnesses, or acts of man, nature,
or God. As a condition for participating in this event, I/we hereby release the Pikes Peak Chapter, the Colorado
Archaeological Society, its member organizers, their agents, Trip Leaders and associated and related parties from
all responsibility for damages, injuries, losses and/or delays due to any reason whatsoever, and accept personal
responsibility for all risks and dangers occurring to, from or on this activity. In addition, I have read, understand, and
will comply with all PPC/CAS Field Trip Policies and Procedures.
MEDICAL INFORMATION AND EMERGENCY CONSENT
I/We, ________________________________________________________, being over the age of 18 confirm to the
Pikes Peak Chapter/CAS that my/our family’s participation does not pose a hazard to me or our family’s health or
that of other participants. I/We impose no specific prohibitions regarding emergency medical treatment unless
stated as follows (if None, please state so):
Please list any allergies to medications by family member(s): ____________________________________________
____________________________________________________________________________________________
In case of an emergency (medical or otherwise), please contact the following person who is my (relationship)
(give name and phone number below, please):
_____________________________________________________
Emergency name and relationship
_________________________________
Emergency Phone Number
_____________________________________
Signature #1
____________________________________
Print name legibly
______________
Date
_____________________________________
Signature #2
____________________________________
Print name legibly
______________
Date
PARENT/GUARDIAN CONSENT FOR MINOR(S) (if applicable)
I understand that my child’s/children’s activities on a Pikes Peak Chapter/CAS field trip or special event may entail
risks of physical injury, including death, and that my child/children may be exposed to hazards, including but not
limited to: weather, unimproved topographic hazards such as cliffs, ravines, caves, loose or falling rocks;
poisonous insects, reptiles, or plants; wild animals; fire, and other such hazards associated with physical activity on
such an outing, and that I, as guardian/parent, assume all such risks. I also further understand that I assume all
risks of possible loss to personal property and belongings.
By signing this consent, I agree that I have discussed with my child/children the policies, procedures and ethics of
Chapter Field Trips and will attest that they understand and will comply with them.
__________________________________________
Name of minor (please print legibly)
__________________________________________
Signature of parent or legal guardian
__________________________________________
Name of minor (please print legibly)
__________________________________________
Date