NOTE: If the requested information is not provided, the participant will not be allowed
to participate in the four-wheeling or camping activities provided by Mountain Rides Near and Far.

PARTICIPANT NAME: ___________________________________________
SIGNATURE OF
PARTICIPANT: _________________________________________________
DATE: _________________________________________________________

In consideration of receiving permission to participate in the four-wheeling and/or
camping activities provided by, Mountain Rides Near and Far, I, for myself and my
heirs, executors, administrators, successors and assigns hereby RELEASE, WAIVE, AND
FOREVER DISCHARGE Mountain Rides Near and Far, and it’s directors, members,
agents, representatives, officers, licensors, employees, contractors, successors,
participants and assigns OF AND FROM ALL claims, demands, damages, costs, expenses,
actions, and causes of action, whether in law or equity, in or to arise by reason of my
participation in the said four-wheeling and/or camping activities, whether as
participant, spectator or otherwise, whether prior to, during, or subsequent to actual
four-wheeling and/or camping activities, AND NOTWITHSTANDING that same may have been
contributed to, or occasioned by, the negligence of any of the aforesaid. I INDEMNIFY all
of the aforesaid from and against any and all liability incurred by any or all of them
arising as a result of, or in any way connected with, my participation in such four-
wheeling and/or camping activities.

I and my next of kin are duly aware of the risks and hazards inherent in four-wheeling
an/or camping activities, and I acknowledge that conditions may be hazardous and
dangerous, and that emergency services may not be readily available. I hereby give notice
that I voluntarily assume all risks of loss, damage, or injury, including death, that may
be sustained by me or to any property in connection with my participation in such four-
wheeling an/or camping activities.

In light the above WAIVER, RELEASE AND INDEMNITY, I recognize that it may be prudent and
advisable that I have appropriate insurance coverages, including health, disability, life
and liability, and I understand that such insurance coverage is NOT provided by, Mountain
Rides Near and Far.

By SUBMITTING this form, I ACKNOWLEDGE HAVING READ, UNDERSTOOD AND AGREED on the above
WAIVER, RELEASE AND INDEMNITY, and I WARRANT that I am physically fit to participate in
the such four-wheeling and/or camping activities. Further, I hereby grant full permission
to any and all of the aforesaid to use any photograph, videotape, motion picture,
recording or any record of such four-wheeling and/or camping activities for any
legitimate purpose.