"*" indicates required fields Part 1 - Your InformationName* First Last Email* Your Phone Number*Company / Sports Team / Group attending the Retreat Centre with? (If Applicable) Your Address* Street Address City State / Province / Region ZIP / Postal Code CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Your Sex* Female Male Prefer not to say Date of Birth* Month Day Year To All Participants in the NexLevel Challenge Ltd. Program: Please read this document carefully. It contains important information about your NexLevel experience and may affect your legal rights in the event of an injury or some other loss. NexLevel Challenge Ltd. (operating as Red Lodge Retreats & NexLevel) programs are designed for those in reasonably good health and incorporate a variety of activities, including games and initiatives and more strenuous low course elements, which are conducted on the ground, indoors and out, and which may involve close personal contact with other persons. Each participant may choose the level of his or her participation. While minimizing risks is a high priority at Red Lodge Retreats, participants must understand there are risks of physical or emotional injury, and must assume those risks. Participants must follow the instructions of the Red Lodge Retreat staff. Risks of Red Lodge Retreat activities include falls, sprains, abrasions and other physical and emotional trauma and in extreme cases even death. Injuries and other losses can result from, among other causes, strenuous activity including the possibility of falling into or onto fixed and other structures and other participants or staff members. Injuries and other losses may be caused also by the carelessness of other participants and staff. Red Lodge Retreats recommends that participants be covered by health and accident insurance during the time of their participation.Covid Policy & Protocol Statement Red Lodge Ropes Course, in these extraordinary times, has been working hard to ensure the safety and well-being of our guests and staff; safety remains our highest priority. As always, all groups must be pre-booked in order to participate in a Ropes Course Team Building or Recreational program. A Red Lodge Ropes Course Waiver must be completed online before you arrive. Washrooms and hand washing are available at the Red Lodge Guest Ranch. A sanitization station will be accessible at the facility and sanitization is strongly encouraged. Everyone must comply with Alberta Covid-19 Public Health Measures. Details on current measures can be found at - www.alberta.ca/coronavirus-info-for-albertans.Participant Agreement* I have read the above and agree Part 2 - In The Event of an InjuryName of Emergency Contact* First Last Emergency Contact Phone Number*Your Relationship* Address* Street Address City State / Province / Region ZIP / Postal Code CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Part 3 - Medical InformationDo you have allergies or reactions to medications?* Yes No As you have selected Yes to the above question – Please explain further here*Do you have any medical conditions or disabilities (temporary or permanent) that may limit your participation?* Yes No As you have selected Yes to the above question – Please explain further here*Are you pregnant or post-partum?* Yes No As you have selected Yes to the above question – Please explain further here*Do you have Atlantoaxial Instability?* Yes No As you have selected Yes to the above question – Please explain further here*Do you have an Active Orthopedic Problem?* Yes No As you have selected Yes to the above question – Please explain further here*Do you have Abdominal Organ Enlargement?* Yes No As you have selected Yes to the above question – Please explain further here*Any other medical limitations?* Yes No As you have selected Yes to the above question – Please explain further here*Part 4 - Medical HistoryIf you answer Yes to any part of the Medical History questions below, NexLevel Challenge strongly recommends you see a physician before participating.Do you currently have, or have a history of Chest Pain?* Yes No Do you currently have, or have a history of Heart Attack?* Yes No Do you currently have, or have a history of Heart Murmur?* Yes No Do you currently have, or have a history of Stroke?* Yes No Do you currently have, or have a history of High Blood Pressure?* Yes No Do you currently have, or have a history of Heart Palpitations?* Yes No Do you currently have, or have a history of Heart Disease?* Yes No Do you currently have, or have a history of Seizures?* Yes No When you exert yourself, do you experience symptoms of any of the above?* Yes No Have you had a kidney or liver transplant?* Yes No I understand that failure to answer this questionnaire in a full and comprehensive manner could affect my own safety and the safety of others. I affirm that the information herein is accurate and complete and I accept full responsibility for any loss i suffer arising out of my failure to fully disclose, in this form or otherwise prior to my activity, a pre-existing medical condition.* I have read the above and agree Part 5 - Assumption of Risks, and Agreements of Release and IndemnityIn consideration of the services of NexLevel Challenge Ltd. (operating as Red Lodge Ropes Course and NexLevel) in offering these activities, I agree as follows: Assumption of Risks: I acknowledge that I understand the activities in which I will be participating, and their risks. I understand that the risks are inherent in the activities – that is they cannot be eliminated without changing the nature and value of the experience. I voluntarily assume all such risks, inherent and otherwise, and whether or not they are described above. Covid-19: I understand and acknowledge that Covid-19, has been declared a worldwide pandemic and is extremely contagious. The Red Lodge Ropes Course has put in place preventative measure to reduce the spread of Covid-19; however, the Red Lodge Ropes Course cannot guarantee that the Participant will not become infected with Covid-19. Further, participation in the activities could increase the Participant's risk of contracting Covid-19. Covid-19 is contagious in nature and the Participant may be exposed to, or infected by Covid-19 and such exposure may result in personal injury, illness, permanent disability or death. Release and Indemnity: I agree not to sue, and to release and hold harmless, NexLevel Challenge Ltd., its owners and staff members with respect to any and all claims which I may now have or acquire in the future, including claims of negligence (but not of gross negligence or intentionally wrongful conduct), arising in any way from my enrollment or participation in Red Lodge Ropes Course activities. I further agree to protect and indemnify (that is, defend and pay any judgments, costs, and attorney’s fees) Red Lodge Ropes Course and the other Released Parties from any claim, including a claim of negligence of a Released Party (but not of gross negligence or intentionally wrongful conduct) asserted by any third party, including (but not limited to) rescuers, other participants in the activities of Red Lodge Ropes Course and members of my family, arising from injuries or other losses either suffered by or caused by me in connection with my enrollment or participation in an activity of Red Lodge Ropes Course. Other: In the event of illness or injury, consent is hereby given to provide emergency medical care, hospitalization or other treatment, which may become necessary. If a suit if filed against NexLevel Challenge Ltd. or any other released party it must be filed in the Province of Alberta. Any such suit will be governed by the laws of the Province of Alberta, not including those laws which may apply the laws of another jurisdiction. Photographic Release: Red Lodge Ropes Course may wish to take photos and videos of participants during the programs. I authorize NexLevel Challenge Ltd. to use my photograph and/or video capture. I understand and agree that; the images could be used in a variety of Red Lodge Ropes Course and NexLevel marketing products and can be reproduced, reprinted and re-used on an ongoing basis. Red Lodge Ropes Course staff, volunteers or suppliers working on the organization’s behalf are released from all claims of any nature arising from the release of this information. If you have privacy concerns about having your photo taken for any reason, please email info@nexlevelteams.com prior to the event to sign a photo exclusion form.Participant Agreement* I have read the above and agree Signature*PhoneThis field is for validation purposes and should be left unchanged.