Mill Road Adventures
Participant Assumption of Risk, Release and Agreement

* 1. Particpants Name:

* 2. Participant Age:

Program:  Leadership Franklin County Youth, Greater Chambersburg Chamber Foundation
In consideration of the services of Mill Road Adventures, their directors, agents, owners, officers, volunteers, participants, employees, and all other persons or entities acting in any capacity on their behalf (hereinafter collectively referred to as Mill Road Adventures), I hereby agree to hold harmless, release, indemnify, and discharge Mill Road Adventures, on behalf of myself, my children, my parents, my heirs, personal representative and estate as follows:

* 3. I acknowledge that my participation during "Adventure Program" activities entails known and unanticipated risks, which could result in physical or emotional injury, paralysis, death, or damage to myself, to property, or to third parties.  I understand that such risks cannot be eliminated without jeopardizing the essential qualities of "Adventure Program" activity.  

Mill Road Adventures programs as based on the "challenge by choice" principle. At any time you and/or your group are free to withdraw from participation in "Adventure Program" activities. The risks include, among other things, the potential for: slips, fall and falling; rope burns; pinches, scrapes, twists and jolts that could result in scratches, bruises, sprains, lacerations, fractures, concussions, or even more severe life threatening hazards. During an activity there may be contact with plants, animals or insects that could create hazards such as stings, allergies and associated diseases. 

Furthermore, Mill Road Adventures have difficult jobs to perform. They seek safety, but they are not infallible. They might be unaware of participant's fitness or abilities, they might misjudge the weather.

By typing my name below I agree the above statement:

* 4. I expressly agree and promise to accept and assume all the risks existing in this activity.  My participation in this activity is purely voluntary, and I elect to participate in spite of the risks.

By typing my name below I agree to the above statement:

* 5. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless Mill Road Adventures from any and all claims, demands, or causes of action, which are in any way connected with my participation in this activity or my use of Mill Road Adventures equipment or facilities, including any such claims which allege negligent acts or omissions by Mill Road Adventures.

By typing my name below I agree to the above statement:

* 6. Should Mill Road Adventures or anyone acting on their behalf, be required or incur attorney's fees and costs to enforce this Participant Agreement, I agree to indemnify and hold them harmless for all such fees and costs. 

By typing my name below I agree to the above statement:

* 7. I certify that I have adequate insurance to cover any injury or damage I may causes or suffer while participating, or else I agree to bear the costs of such injury or damage to myself.  

By typing my name below I agree to the above statement:

* 8. I further certify that I have no medical, mental, emotional, or physical conditions, which could interfere with my safety in this activity, or else I am willing to assume - and bear the costs of - all risks that may be created, directly, or indirectly, by any such condition.  

By typing my name below I agree to the above statement:

* 9. In the event that I file a lawsuit against Mill Road Adventures, I agree to do so solely in the courts having jurisdiction in Franklin County, Pennsylvania, and I further agree that the substantive law of the Commonwealth of Pennsylvania shall apply in that action without regard to the conflict of law rules.  I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect. 

By typing my name below I agree to the above statement:

* 10. By signing this document, I acknowledge that if anyone is hurt or property is damaged during my participation in this activity, I may be found by a court of law to have waived my right to maintain a lawsuit against Mill Road Adventures on the basis of any claim from which I have released them herein. 

By typing my name below I agree to the above statement:

Folium Inc. d/b/a Mill Road Adventures
7564 Brown's Mill Road
Chambersburg, PA 17202
717-375-4834

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