"*" indicates required fields Part 1 - Youth's InformationYouth's Name* First Last Sports Team you are with Youth's Sex* Female Male Prefer not to say Date of Birth* Month Day Year Part 2 - Parent/Guardian InformationName of Parent/Guardian (First and Last)* First Last Address of Parent/Guardian* 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 Parent/Guardian Email* Parent/Guardian Phone Number*To All Participants in the NexLevel Challenge Ltd. Program: Please read this document carefully. It contains important information about the NexLevel experience and may affect your legal rights and those of your child in the event of an injury or some other loss. This document must be executed by at least one Parent/Guardian. NexLevel Challenge Ltd. (operating as Red Lodge Ropes Course and NexLevel) programs are designed to be age appropriate and well within the capabilities of children in reasonably good health. They incorporate a variety of activities including games and problem solving initiatives. Each child may choose the level of his or her participation. Minimizing risks is a high priority at Red Lodge Ropes Course, but participants and their families must understand there are risks of physical or emotional injury, and must assume those risks. While the risk of injury is small, participants may suffer sprains, abrasions and other, more serious, physical and emotional trauma. Injuries and other losses can result from, among other causes, moderate to strenuous activity including the possibility of falling, abrupt contact with fixed and other objects and persons, close personal contact with other participants or staff members, including the possibility of inadvertent touching due to harnessing, and misjudgments of other participants. Red Lodge Ropes Course recommends participants are covered by health and accident insurance for the duration of their participation. Managing risks effectively is very important in all our programs at Red Lodge Ropes Course. Please help us by providing the information requested below. Let us know if your child has any condition (current or past) that could affect his/her involvement in all activities and provide any other information that will help us provide a productive and enjoyable experience. 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 3 - Medical InformationDoes the youth have any medical conditions or disabilities (current or past) that may limit their participation?* Yes No As you have selected Yes to the above question – Please explain further here*Is the youth currently taking any medications?* Yes No As you have selected Yes to the above question – Please explain further here*Does the youth have allergies or reactions to medications?* Yes No As you have selected Yes to the above question – Please explain further here*Does the youth have a chronic or recurring illness?* Yes No As you have selected Yes to the above question – Please explain further here*Has the youth had a recent injury or infectious disease?* Yes No As you have selected Yes to the above question – Please explain further here*Does the youth have any seizure disorders?* 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 - 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, Parent/Guardian, for myself and on behalf of my minor child, agree as follows: Assumption of Risks: I am aware Red Lodge Ropes Course programs are meant to be physically challenging as well as educational. I understand even though Red Lodge Ropes Courses programs are designed and operated by skilled and experienced staff, the risk of injury cannot be eliminated. I understand further that the risks described above, and other risks are inherent in the activities – that is, they cannot be eliminated without changing the nature and value of the experience. I have discussed the Red Lodge Ropes Courses activities and their risks with my child. He or she understands them and wishes to participate nevertheless, and the child and I expressly 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: For myself and, to the maximum extent allowed by law, on behalf of my child, I agree to release and to indemnify (“indemnify” meaning to protect, defend and pay any judgments, costs, and attorney’s fees) NexLevel Challenge Ltd., its owners and staff members with respect to any and all claims, including claims of negligence (but not of gross negligence or intentionally wrongful conduct), arising in any way from injuries or other losses suffered by the child or caused by the child, in connection with the child’s enrollment or participation in Red Lodge Ropes Course activities. Other: In the event of illness or injury to the child, consent is hereby given to provide emergency medical care, hospitalization or other treatment, which may become necessary, and to exchange medical information with third party care givers. I will pay or reimburse NexLevel Challenge Ltd. or any other Released Party for any and all costs including attorneys fees, associated with defending a claim brought by me or by or on behalf of my child to the extent that claim is dismissed or recovery for it is denied. If a suit is 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. If any part of this agreement is deemed invalid by a court of competent jurisdiction, the remainder of the agreement will nevertheless remain in full force and effect. 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.Parent/Guardian Agreement* I have read the above and agree Signature*PhoneThis field is for validation purposes and should be left unchanged.