Ceta Canyon Release Form - HIS Camp 2025

Please read and understand this document before signing. If you have any questions please ask us or consult an attorney.

Your name *

Email address *

Exceptions: *

I (or my child) have no medical condition that would prevent participation in this activity except:
(If none, please put N/A)

I fully understand and agree to the below terms and conditions. *

The proposed activity provided by Ceta Canyon Camp and Retreat Center requires participation in physical exercises which are by their nature, physically demanding. Many of the activities will challenge you and cause surges in blood pressure and pulse rates. Therefore, all participants must be free of medical or physical conditions, any heart related or other diseases, which might create undue risks to themselves or any others that depend on them. Good physical condition will increase your enjoyment of the outdoor activities. If there is any doubt about your ability to safely participate in this experience, you should have a physical examination.

Participant Information

Please fill out the following information for the first participant.

First and Last Name: *

Date of Birth: *

Phone Number *

Address *

Emergency Contact

In case of emergency please notify:

First and Last Name: *

Address: *

Physician's Information

Name of Physician: *

Physician Phone: *

Phone Number: *

Date of Last Physical Examination: *

Representation and Emergency Authorization *

This health history is correct so far as I know, and I believe that my health (or that of my minor child) is satisfactory to participate in Challenge Course activities. I hereby give permission to the medical personnel selected by Ceta Canyon Camp and Retreat Center to order injection and/or anesthesia and/or surgery for me (or my minor child). Such authorization for emergency treatment shall also include but not be limited to, charges incurred for the providing of aid and arranging evacuation if Ceta Canyon Camp and Retreat Center or its agency determine that such evacuation is necessary or desirable. I further agree to assume responsibility for the costs of any specialized means of evacuation and of any medical care and acknowledge that these costs are the financial responsibility of the undersigned. I also understand and agree to abide by any restrictions placed on my (or my minor child’s) activities.

Acknowledgment of Risk *

Ceta Canyon Camp and Retreat Center wants to do everything possible to assure that our guests experience a rewarding experience. We wish to inform our guests that participation in the Challenge Course is not risk free. The same elements that contribute to the unique character and fun of a Challenge Course such as the physical exertion or the risk can cause loss or damage to equipment, injury, illness, or in extreme cases permanent trauma or death. We do not want to heighten or reduce your enthusiasm for the experience, but we do want you to know in advance what to expect, and to be informed of the same of the possible risks. We ask that you read this, sign it, and return it to our office.
A challenge or ropes course is a series of tasks, obstacles or challenges that the participants will travel through, on or around during the course. Most obstacles involve physical activity such as crawling, walking, climbing or movement which uses all or part of your body. Some of the obstacles will be off the ground. Participants may experience exhaustion or tiredness from the course. A large amount of physical exertion will be required.

Participants may be wearing a harness (or harnesses) and helmet and tied into ropes suspended by cables. This system is designed as a safety system. However, a fall in a harness can be painful. Participants may experience a jolt and a tightening of the harness. Sitting or hanging in a harness for a period of time may be uncomfortable. Participants may experience rope burns from the ropes or cables traveling through their hands. Participants can fall against the rope or other objects while on the course. Participants may fall to the ground from heights of varying distances.

Participants will often experience and confront several types of fear or discomfort.

Accidents can occur traveling to and from the course. Trails are often steep, rocky, and slippery. Hikes involve crossing streams, where footing can be awkward. Participants can slip or fall during a hike, resulting in injury. Poisonous or dangerous plants, insects or animals can be found with harmful effects to some guests. Exposure to the natural elements can be uncomfortable or harmful. Heat, sunburn, dehydration, heat exhaustion, heat stroke, heat cramps, cold, wind, rain, restroom facilities may be a long walk from activity area, eating meals out-of-doors, or being in the open for the extended length of the trip can be uncomfortable or cause injury or illness.

It is also possible that some participants would suffer mental anguish or trauma from the experience or their injuries.

This list is not an exclusive or exhaustive list of possible injuries, trauma, or accidents that may occur while on the Challenge Course. Most of these injuries are rare and you are not likely to encounter them, however they have occurred within the Challenge Course Industry and you need to know about them and other possible injuries not mentioned above. These injuries occur more often when the participants are using drugs or alcohol or not physically able to undertake the Challenge Course.

I certify that I or my minor child listed are fully capable of participating in a Challenge Course program. I state that I have read the above statement on some of the possible risks in this Challenge Course. Therefore, I assume full responsibility for me or my minor child listed, for bodily injury, death and loss of personal property and any expenses as a result of my negligence, negligence of my family, or the negligence of Ceta Canyon Camp and Retreat Center. I also understand that Ceta Canyon Camp and Retreat Center reserves the right to refuse any person it judges to be incapable of meeting the rigors and requirements of participating in Challenge Course. Myself or my minor child listed are in good physical condition and able to undertake this Challenge Course.

Insurance

Please enter your insurance information below.

Insurance Carrier: *

Health History

Please answer the following questions about your health history.

Have you had or do you currently have any heart problems? *

Do you frequently suffer from pains in your chest? *

Do you often feel faint or have spells of severe dizziness? *

Has a doctor ever told you that you have high blood pressure? *

Do you have arthritis, joint or back problems that might be aggravated by exercise? *

Have you had any operations or serious injuries? *

Do you have any disabilities or chronic recurring illness? *

Are there any activities to be limited/discouraged by physicians advice? *

Do you have epilepsy? *

Do you have diabetes? *

Do you have any prescribed meal plan or dietary restrictions? *

Other Health Information:

Are you currently sick and/or using a medication that's not listed above? *

Are you allergic to any medicines, insects or pollen? *

General Health Statement: *

Please provide in the space below any additional information about the attendee's health that you think important.

Contract, Waiver, Release and Indemnification *

agree to indemnify and hold harmless Ceta Canyon Camp and Retreat Center their agents and employees from all claims, damages, losses, injuries and expenses arising out of or resulting from my family's or my participation in these activites. I further agree to release, acquit and covenant not to sue Ceta Canyon Camp and Retreat Center, their agents and employees for all actions causes of action claims or damages, damages in law or remedies in equity of whatever kind, including the negligence of Ceta Canyon Camp and Retreat Center or my family, myself or my heirs, against Ceta Canyon Camp and Retreat Center arising out of participation in this program. In short, I cannot sue Ceta Canyon Camp and Retreat Center and if I do, I cannot collect any money.

I agree that the site of any lawsuit and the law governing any such lawsuit shall be Randall County, Texas and governed by Texas law. The terms of this agreement shall continue and be in effect after the Challenge Course event has ended.

As liquidated damages, I hereby agree that if Ceta Canyon Camp and Retreat Center is forced to defend any action, lawsuit or litigation by myself, my executors, or my heirs, on my family's or my behalf, my heirs or executors and I agree to pay Ceta Canyon Camp and Retreat Center's costs and attorney fees if they successfully defend such action, lawsuit or litigation.

Should any paragraph or part of this agreement be declared unenforceable by a court of competent jurisdiction, the remaining parts or paragraphs shall remain in full force and effect. A copy of this release can be used as if it was an original.

I authorize and release Ceta Canyon Camp and Retreat Center the use of my (or my minor child's) image in any photograph or video recording for any purpose of Ceta Canyon Camp and Retreat Center.

I have adequate health, disability and life insurance for my family and myself.

Policy Number: *

Suggestions or other health related information:

Prior Experience:

By checking this box, l indicate that (or my minor child) have previous Challenge Course experience.

Ceta Canyon Camp & Retreat Center Schaeffer Challenge Course Participant Guidelines *

These guidelines are meant to help you have a fun and comfortable time while at the Ceta Canyon Challenge Course. If you have any questions, please contact us at 806-488-2268.
1. The Challenge Course is open to groups of various ages. Low ropes participants must be age 5 or older. High ropes participants must have completed the fifth grade.
2. No open-toed or open-heeled shoes allowed on the course. No sandals are allowed.
3. Participants should wear modest clothing. Imagine yourself 30 feet in the air straddling a cable, climbing over a log or rappelling backwards wearing a waist harness. Shorts are fine, but no short
shorts, please.
4. Leather gloves are optional, but helpful if rappelling.
5. The canyon is usually warm, if not hot, in the summer, with mild winters. Please drink water before you come and bring additional water with you. Also remember sunscreen, sunglasses, light-colored
clothing, and bug repellent for added protection.
6. Larger groups may be divided into smaller groups.
7. All participants must fill out and sign a Medical History, Agreement to Participate, Assumption of Risk, and Release of Liability form.
Participants under 18 must have this form signed by a parent or guardian.

Parent/Guardian Signature: *

By checking this box, I understand that of my own free will, for my family, my minor children, my heirs and executors and I have read, understand and acknowledge the risks and liability for myself and my family.

Today's Date: *

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