Mailing Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number *

(###)

###

####

Gender *

Male

Female

Birthdate *

MM

DD

YYYY

Marital status *

Married

Single

Do you have a current passport? *

Yes

No

Passport Expiration Date

MM

DD

YYYY

If asked, I am willing to and able to pass a government background check *

Yes

No

Authorization and Agreement *

The information on this application is accurate and true to the best of my knowledge. I understand that I am giving 501 Collective the right to use my picture, voice and/or testimony in any form of promotional advertising materials. I also understand that once accepted to this trip, I am responsible for the full price of the trip. I understand that to remain tax-deductible, donations connot be refunded for any reason. I undersand all donations are tax-deductible to the full extent of the law, so far as not goods or services were exchanged. I also understand that any funds not raised by support at my trips set payment dates will be charged to the credit card I will provide. You will receive a receipt recognizing your donation in January following the year of donation. In consideration for receiving permission of 501 Collective, to participate in the trip, I hereby release, waive, discharge and covenant not to sue, 501 Collective, The Board, Their officers, agents, servants, or employees (hereinafter referred to as releasees) from any and all liability, claims, demands, actions, and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by me, or any of the property belonging to me, whether caused by the negligence of the releasees, or otherwise, while participating in such activity, or while in, on or upon the duration of the trip.

I agree

Liability Release *

Liability Release RECREATIONAL ACTIVITY RELEASE OF LIABILITY, WAIVER OF CLAIMS, EXPRESS ASSUMPTION OF RISK AND INDEMNITY AGREEMENT.             Please read and be certain you understand the implications of signing. Express Assumption of Risk Associated with All Recreational Activities. In signing this release form I am stating that 501 Collective is not responsible for any injuries to my person or property. I understand all inherent hazards and risks associated with all activities, including non-scheduled recreational activities, scheduled events led by or associated with 501 Collective, and any extreme sports. Including the rental of equipment and transportation associated therewith in which I am about to engage. Inherent hazards and risks (include but are not limited to): 1. Risk of injury from the activity and equipment utilized is significant including the potential for permanent disability and death. 2. Possible equipment failure and/or malfunction of my own or others' equipment. 3. If this activity takes place outdoors and therefore includes risks associated with exposure to elements, excessive heat, hypothermia, impact of the body upon water, injection of water into my body orifices, encountering objects either natural or manmade, exposure to animals with the attendant risk of kicking, biting, shying away, running or otherwise moving in an unanticipated manner causing injury and/or death. 4. My own negligence and/or negligence of others, including but not limited to operator error and guide decision making including misjudging terrain, rapids, weather, trails, or route location. 5. Attack by or encounter with insects, reptiles, and/or animals, including any virus or illness they transmit. 6. Accidents or illness occurring in remote places where there are no available medical facilities. 7. Fatigue, chill, and/or dizziness, which may diminish my/our reaction time and increase the risk of accident. *I understand the description of these risks is not complete and unknown or unanticipated risks may result in injury, illness, or death.             Release of Liability, Waiver of Claims and Indemnity Agreement             In consideration for being permitted to participate in the activity (ies) described above and related activities, I hereby agree, acknowledge and appreciate that: Liability Release 1. I HEREBY RELEASE AND HOLD HARMLESS WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER CAUSED BY NEGLIGENCE OR OTHERWISE, the following named persons or entities, herein referred to as the releasee - 501 Collective. 2. To release the releasee, their directors, employees, representatives, agents, and volunteers, and vessels from liability and responsibility whatsoever and for any claims or causes of action that I, my estate, heirs, survivors, executors, or assigns may have for personal injury, property damage, or wrongful death arising from the above activities whether caused by active or passive negligence of the releasee or otherwise. By executing this document, I agree to hold the releasee harmless and indemnify them in conjunction with any injury, disability, death, or loss or damage to person or property that may occur as a result of engaging in the above activities. 3. By entering into this Agreement, I am not relying on any oral or written representation or statements made by the releasee, other than what is set forth in this Agreement. This release shall be binding to the fullest extent permitted by law. If any provision of this release is found to be unenforceable, the remaining terms shall be enforceable. Donation Acknowledgment I agree and understand that all donations, support, and gifts to my trip or 501 Collective, with an expression of a preference for my trip expenses, are tax deductible to the extent allowed by law. All donations are non-refundable. Photography Consent I hereby grant, voluntarily and with full understanding, to 501 Collective the license to use and store my name and image, by means of digital or film photography, video photography, audio recording or other documentation, with respect to the selected activities, hosted by 501 Collective. I also grant use of any stored data including my name and image in printed publications, electronic publications, social media outlets and / or in any website created by or for 501 Collective for its sole benefit. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, AND I FULLY UNDERSTAND ITS TERMS, AND UNDERSTAND THAT I HAVE GIVEN UP LEGAL RIGHTS BY SIGNING IT, ANDI SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

Yes, I agree

Name *

First Name

Last Name

Today's Date *

MM

DD

YYYY