Youth Application

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Parent/Legal Guardian 2

Alternate Emergency Contact

Grand Canyon Youth will only contact an Alternate Contact after first attempting to connect with the parent(s)/guardian(s).

Participant Health Information

As parent/guardian, GCY relies on you to provide thorough and accurate information about your child’s health history. Your child is traveling to a wilderness area and may be more than 24 hours away from definitive care. It is important that you advise GCY of any changes to your child’s medical condition prior to their expedition. GCY guides have wilderness first aid training (WFR), but they are not medical professionals. The confidential information provided in this form is shared only with applicable parties and program staff.

In the event of an injury or illness requiring medical care for the participant, I hereby give permission and consent to attending medical personnel, Grand Canyon Youth’s officers, directors, employees, representative agents, volunteers, contract individuals and all other persons or entities associated with it, to render any and all necessary treatment, including administration of epinephrine.

AGREEMENT TO ASSUME ALL RISKS; RELEASE OF LIABILITY/ AGREEMENT NOT TO SUE & TO INDEMNIFY

Please read this contract carefully. It releases Grand Canyon Youth from liability and waives certain rights.

In consideration of being permitted to participate in an adventure trip with Grand Canyon Youth, Inc., an Arizona nonprofit corporation (“GCY”), I, the Participant (or, if the Participant is under the age of 18, I on the Participant’s behalf), understand, acknowledge, and contractually agree as set forth below (the “Agreement”):

1. Acknowledgement of Dangers and Risks:

I understand, acknowledge, and agree that participating in outdoor pursuits including rafting, camping on a river expedition, and related transport by GCY to and from these activities (hereinafter collectively the “Activity”) can be HAZARDOUS AND INVOLVE THE RISK OF PHYSICAL INJURY AND/OR DEATH. I understand, acknowledge, and agree that participating in the Activity involves certain inherent dangers and risks that cannot be eliminated or controlled by GCY, the presence of which are integral to the recreational and adventurous nature of the Activity. I understand and agree that the following list of dangers and risks that could cause physical or emotional injury or death is not exhaustive, and I understand that there are many other dangers or risks associated with the Activity not listed below: a) Risks associated with boating and being around or in water, including: falling into water including with submerged or unknown hazards; water immersion, including drowning; bank collapse; injurious contact with natural and manmade objects; foot entrapment; striking and/or becoming entangled with strainers, rocks, or other objects under, near, or above the surface of the water; injury or lacerations due to injurious contact with sharp vegetation, rocks, metal, glass, or other objects in the water; changing or unexpected natural or man-made water conditions; prolonged exposure to cold water leading to hypothermia, injury, or death; physical over-exertion; sunburn; slipping, tripping, or falling while wading or walking along the water’s edge; injuries caused by misjudging water depth or current; existing, changing, or otherwise hazardous water conditions, including strong currents, waves, undercurrents, whirlpools, eddy lines, large waves, and shallow water; harmful or toxic algal (algae) blooms; water and land pollution and debris; jolting or jarring resulting in contact with hard objects including oars, boating equipment, the body parts of others; failure to properly control a watercraft; collisions with other watercraft, rocks, the bank, or other natural or manmade objects; capsizing or flipping watercraft; being separated from watercraft; impact of the body upon the water; injection of water into body orifices; becoming tangled in ropes; getting trapped or caught beneath an overturned watercraft; trapped limbs; improperly rigged gear or equipment; failure to properly use or maintain equipment resulting in its failure or malfunction, including helmets and personal floatation devices (PFDs); changing or unexpected natural or man-made river/ocean conditions; slipping, tripping or falling around or from boats including while boarding or disembarking boats; burning associated with hot surfaces and sun; striking and/or becoming entangled with overhanging trees; slippery or hot boating equipment; inadequate or lost footwear; injuries caused by using, moving, or lifting boating equipment; boating equipment malfunction, including popping or deflating watercraft; jolting, jarring, bouncing and colliding with equipment or other passengers; compression hazards associated with wave slapping or bouncing; and errors in guide’s judgment or lapse in guide’s skill; injury resulting from jumping from heights including cliff or rock jumping; lack of access to or inability to receive weather-related warnings while after embarking on the trip including flash flood or heavy rain warnings or information; b) Risks associated with transport in a motor vehicle, including: all commonly understood risks of riding in a vehicle, including crashes; mechanical and equipment failure, malfunction, or failure to operate as intended, including fire or explosion; manufacturing defects; risks associated with riding in a vehicle in remote terrain on backcountry unimproved roads; burning associated with hot surfaces and sun; collisions and traffic accidents; ejection from a vehicle; overturning of a vehicle; burns; falling out of a vehicle; errors in or driver judgment or lapse in driver skill; c) Risks associated with camping, hiking, and other outdoor activities, including: slipping, tripping, or falling; variations in terrain; rough or unmaintained trail; injury caused by campsite hazards such as tent lines and stakes, tent collapse, entering or exiting tent, uneven tent-site, and low light; wet, slippery, or uneven trails or walking surfaces; exposure to steep terrain; trail and ledge side drop offs; erosive cliff edges; path and/or trail obstructions and other unmarked, obscured, or unseen hazards in the outdoor environment; unstable or loose rock, ice, snow, or other terrain; existing, changing, or otherwise dangerous snow, ice, rock and/or trail conditions; loss of balance; dizziness and/or vertigo; fatigue; navigational errors, difficulty with route finding, and/or getting lost; exposure to heights; exposure to falls from great heights; loss of balance; lack of or inadequate shelter; injury caused by inadequate footwear; lack of water or proper nourishment; injuries associated with carrying a weighted pack; injuries associated with inadequate or ill-fitting footwear, clothing, or pack; rashes and abrasions from footwear and pack; blisters; infection; errors in staff judgment and/or lapse in staff skill; injury caused by campsite hazards such as tent lines and stakes, tent collapse, entering or exiting tent, uneven tent-site, and low light; cooking related dangers; exposure to food allergens; burns or burning associated with campfires, cook stoves, hot surfaces, and sun exposure; d) General risks associated with participating in the Activity, participating in the Activity with other participants, and relying upon staff, including: falling into the water from onshore; dangerous water crossings; lack of or inadequate shelter; getting lost; allergen exposure; exposure to poisonous plants; exposure to various dangerous or diseased wildlife or insects, including bee, wasp, or scorpion stings, and bites from ticks, bats, snakes, rodents, and venomous reptiles; falling trees, limbs, rocks, or other objects; moving objects associated with extreme weather; changing weather; dangerously cold temperatures, dangerously hot temperatures, wind, hail, tornado, heavy rain, and other adverse weather conditions; temperature fluctuations; extreme or partial darkness; landslides; mudslides; flashfloods; water and debris fall; wildfire or uncontrolled camp fire and associated smoke; injuries caused by aiding others; exposure to food-borne, water-borne, vector-borne, or airborne bacteria, virus, or pathogens; all manner of outdoor injuries or ailments including brain injury, head injury, spinal injury, joint injury, broken bones, paralysis, sprains; physical over-exertion; mental or physical shock; internal injury, sickness or disease, hypothermia, frostbite, sunburn, heatstroke, dehydration, and hyponatremia; exacerbation of Participant’s own health condition(s); diminished ability to react; overexertion and fatigue; bodily failure while carrying heavy equipment or objects; inadequate or improper clothing, footwear, or equipment; flying man-made objects such as balls, frisbees, gear, or equipment; failure to understand and follow guide instructions; Participant’s failure to wear protective gear or clothing; Participant’s failure to estimate and operate within Participant’s experience; Participant’s failure to use equipment appropriately or effectively; mentally or physically unstable or criminal trip participants or others; negligence by trip participants or others; lack of access to immediate medical care due to remote location; inadequate or incorrect medical care; poorly executed or failed rescue attempts; dangerous contact with rescue vehicles, watercraft, or aircraft; failure or lack of communication equipment; inadequate or malfunctioning equipment; errors in guide judgment or lapse in guide skill; and mental, physical, or emotional injury or distress from exposure to any of the above. I understand that GCY has done its best to list the known risks of participating in the Activity, and I agree that I have the right, obligation, and opportunity to research and verify the risks of participating in the Activity.

2.Acknowledgement of Limitations of Equipment:

I acknowledge and agree that any and all equipment provided by GCY may malfunction, fail, not fit properly, or otherwise not function as intended. I agree that I will use the equipment only as instructed. I agree that if I do not understand how to use or operate the equipment utilized for the Activity, I will request further instruction or assistance. I acknowledge and agree that a) GCY requires that I wear a personal floatation device (PFD) at all times while on the water; and b) although this equipment is required, this equipment is no guarantee of my safety, and such equipment may not protect me from all injuries, including the types of injuries that the PFD is designed to prevent. I understand that if I provide my own equipment, I am responsible for its maintenance and use. I acknowledge that not all conceivable safety equipment is included and that Participant must supply any safety equipment they deem advisable or necessary for the Activities beyond what is provided.

3. Assumption of Risk:

I acknowledge and agree that I am choosing to take part in the Activity despite the dangers and risks of doing so, and I freely choose to accept the risks of participating in the Activity. I recognize that property loss, physical or emotional injury, and death are all possible while participating in the Activity. I expressly acknowledge and assume all risks, dangers, and consequences of the Activity, including but not limited to those risks, dangers, and consequences set forth in paragraph 1, above, that may result in physical or emotional injury, property damage, or death, but not including those conditions that result from GCY's negligence.

4. Participant’s Responsibilities and Representations:

I represent that I am physically and mentally capable of participating in the Activity. I understand the importance of all safety instructions given to me, whether in writing, verbally, or visually, and I agree to follow all staff and guide instructions at all times while engaging in the Activity. I understand and agree to follow all rules, and I certify that I meet all requirements for participation in the Activity. Further, I represent that I have had the opportunity to both independently research and discuss with GCY the risks of participating in the Activity and my assumption of those risks. I have been informed of and understand the expectations of me while engaging in the Activity. I acknowledge that if I consume drugs or alcohol, I will bear sole responsibility for myself and for any damages I may cause to GCY, its property, or to other participants. I agree that GCY reserves the right to remove Participant from engaging in the Activity if it deems, in its sole discretion, that such removal is appropriate and necessary. I have been informed of the increased risk associated with running higher classes of whitewater, particularly Class IV whitewater, and of the changing nature of such risk as water levels change. I understand that I am responsible for truthfully disclosing and notifying GCY of any risk to me or other participants associated with my own mental or physical conditions, including allergies that could result in anaphylaxis. I specifically and expressly agree that I have full responsibility for managing and treating any such conditions to prevent injury to myself or others. I am not relying on any prior oral, written, or visual representations made by GCY, including in any website or promotional materials, to induce me to participate in the Activity. I acknowledge and agree that although a PFD (i.e., personal floatation device) or other safety equipment may be provided, this equipment is no guarantee of my safety, and such equipment may not protect me from all injuries, including the types of injuries that the PFD or other safety equipment is designed to prevent. I understand that not all conceivable safety equipment is provided and that I will provide any safety equipment I deem necessary or advisable for the Activity, including helmets. With all of the foregoing in mind, I assume full responsibility for my own safety.

5. Release of Liability and Agreement Not to Sue:

Fully understanding the foregoing paragraphs, and in exchange for GCY’s agreement to allow the Participant to participate in the Activity, I HEREBY AGREE NOT TO SUE GRAND CANYON YOUTH INC. ("GCY"), its affiliated companies and subsidiaries, or any of their respective successors in interest, affiliated organizations and companies, insurance carriers, agents, contractors, employees, representatives, assignees, officers, directors, and (each hereinafter a “Released Party”) for any damage (including but not limited to equipment damage), injury, or loss to Participant, including death, that Participant may suffer arising in whole or in part out of Participant’s participation in the Activity. By signing this Agreement Not to Sue, I am releasing any right to make a claim or file a lawsuit against any Released Party. I agree to hold harmless and release each and every Released Party from any and all liability and/or claims or causes of action for injury or death to persons or damage to property arising from Participant’s participation in the Activity, INCLUDING, BUT NOT LIMITED TO THOSE CLAIMS BASED ON ANY RELEASED PARTY’S ALLEGED OR ACTUAL NEGLIGENCE or breach of any contract and/or express or implied warranty.

6. Agreement to Indemnify:

I agree to INDEMNIFY (REIMBURSE) each Released Party from and for any and all claims of the undersigned Participant and/or a third party arising in whole or in part from Participant’s participation in the Activity. In other words, if Participant and/or anyone on Participant’s behalf files any lawsuit or brings any claim for injury or damage against any Released Party, undersigned Participant will be required to pay back to the Released Party or Parties all sums of money incurred by or paid by or on behalf of the Released Party or Parties on account of the bringing of such suit or claim, including all attorneys’ fees and costs.

7. Medical Authorization, Release, and Indemnification:

I hereby a) authorize GCY to undertake any emergency medical care for Participant; b) authorize GCY and/or their authorized personnel to call for medical care for the Participant or to transport the Participant to a medical facility or hospital if, in the opinion of such personnel, medical attention is needed; c) agree that, following Participant’s transport to any such medical facility or hospital, GCY shall not have any further responsibility for Participant; d) agree to pay all costs associated with the medical care and related transportation provided for the Participant; and e) shall hold GCY harmless from any claims associated with such medical care, rescue, and/or related transportation, except for those claims based upon GCY’s negligence.

8. Application of Agreement to Minor Participants:

In the case of a minor Participant, I, as parent or legal guardian, acknowledge that I am not only signing this Agreement on my own behalf, but that I am also signing this Agreement on behalf of the minor Participant, and that the minor shall be bound by all of the terms of this Agreement. I agree that but for the foregoing, the minor Participant would not be permitted to participate in the Activity, and I sign this document out of a desire to have the Participant be allowed to participate in the activity. I represent that I am a legal parent or guardian of the minor Participant.

9. Representation of Capacity to Contract, and Acknowledgement That Agreement is a Binding Contract:

I represent that I am at least 18 years of age, and that I have the capacity to understand and be bound by all of the provisions of this Agreement. I understand and acknowledge that this Agreement is a contract and shall be binding to the fullest extent permitted by law. It is my intent that this Agreement shall be binding upon my assignees, subrogors, distributors, heirs, next of kin, executors, and personal representatives, and those of the Participant.

10. Agreement to Application of Arizona Law and Selection of Forum:

I agree that any and all claims directly or indirectly arising from or related to this Agreement, including any and all tort or contract claims arising from my participation in the Activity under this Agreement, shall be governed by Arizona law, and that the exclusive jurisdiction for any such claim shall be in the Superior Court of Coconino County, Arizona, without regard to where the incident giving rise to any lawsuit occurs and without regard to any jurisdiction’s conflicts of laws analysis.

11. Miscellaneous Provisions:

If any sentence, clause, paragraph, or part of this Agreement is declared unenforceable, the remainder shall continue in full force and effect. This Agreement can be modified only in writing. An electronic signature or acknowledgment upon this Agreement is fully binding and enforceable, and a copy of this executed Agreement may be used as if it is the original. I agree that any subcontractors or other vendors utilized by GCY during or incidental to the Activity are solely responsible for injury that occurs to me while I am in their care, and that GCY is not in a joint venture with any such vendor. I agree that GCY is not a common carrier.

I HAVE CAREFULLY READ THE FOREGOING THREE PAGE AGREEMENT AND UNDERSTAND ITS CONTENTS. I AM AWARE THAT I AM RELEASING CERTAIN LEGAL RIGHTS THAT I OR MY MINOR CHILD MAY OTHERWISE HAVE. I AGREE TO BE FULLY BOUND BY THE TERMS OF THIS AGREEMENT.

There are inherent risks involved with participating in the GCY expedition. It is a parent’s/guardian’s responsibility to become informed about these risks and make a deliberate choice in supporting your child’s participation. Many of the known risks are listed in the liability waiver that is a part of this application, but parents/guardians have the affirmative and final obligation to become informed about GCY programs prior to allowing their child to participate.

• * We rely on parents’/guardians’ judgment to not involve their child in our expeditions if they believe the child could pose a behavioral risk to themselves or others. Knowing disregard of this potential risk may result in parent/guardian liability.
• * GCY is a private, nonprofit organization. We have the right to exclude any participant who we believe, at our sole discretion and for any reason, could pose a risk to themselves or other participants beyond our ability and resources to manage within an appropriate standard of care. All participants must meet GCY’s “Essential Eligibility Criteria.” (Can be found on our website) Parents/guardians must review this document and hereby certify that their child meets the stated criteria.
• * If Trip Leaders and/or Trip Coordinators have cause to believe any participant is unwilling to follow directions, safety rules, the law, or represents an unacceptable risk to themselves or to others, that participant may be separated from the group and evacuated from the expedition at the expense of parents/guardians. Participant may be held legally responsible if they break any law while participating in the GCY expedition.
• * Parents/Guardians hereby agree to talk with their child about the requirements of participation in a GCY program, stressing the importance of following all expectations and safety practices set by GCY.
• * Parents/Guardians should encourage their child to communicate any concerns immediately with adult supervisors on the expedition.

I have read and acknowledge the information and requirements in this form and consent to my child’s participation in a GCY expedition knowing of all above risks. My child fully understands, and they will adhere to all expectations outlined in the personal contract. My child may also participate in all activities pertaining to GCY, including fundraisers, community service projects, transportation, and river expeditions during their involvement. Breach of this contract may lead to participant’s dismissal from the expedition.

I hereby grant Grand Canyon Youth, its co-sponsoring organizations, partners, media representatives, employees, volunteers, and trip participants the right to photograph, record, or film my child’s participation in a Grand Canyon Youth program without recompense. This includes the right to use photographs, audio, or film in promotional, documentary, online, print, digital, and media outlets.

For everyone's privacy, we ask that anyone who receives images does not share/post images of children other than their own.

Please help us understand the circumstances that demonstrate your financial need. We appreciate your honesty.

I hereby certify that all provided information is accurate and complete. I am requesting only what we need and I understand that funds are limited. I understand that completing this application form is not a guarantee of being awarded financial aid.