Andy Boos Outdoor Leader
Hold Harmless, Health, & Safety Form - 2022

Fill this form out and submit electronically, or print it out, fill in it, and bring it with you on your first trip.

        In consideration of Andy Boos Outdoor Leader granting the undersigned the opportunity of attending or participating in Outdoor recreation programs, to be held during the calendar year 2022, for the purpose of leisure enjoyment; and the undersigned recognizing the fact that no benefits are derived by Andy Boos Outdoor Leader by allowing the undersigned to attend or participate. I, the undersigned, hereby release and hold harmless Andy Boos Outdoor Leader and its officers, employees and agents from any and all liability claims, damages, costs, and expenses for both personal injury and/or property damage which may arise as a result of my, or my child's participation in the program.  I agree to assume all risks associated with the program.

        In case of emergency, and you are unable to contact me/us and/or you believe it is necessary to obtain the services of a doctor and/or hospital without first contacting me/us, I hereby authorize you and my doctor or hospital to immediately render all services and treatment deemed necessary at my/our expense.

Medical / Health Issues

Please list any medical conditions, physical limitations, allergies, or current health issues that Andy or other trip leader(s) should be aware of. THIS CAN BE VERY IMPORTANT IF FIRST AID OR MEDICAL TREATMENT IS RENDERED.  (Examples: Asthma, Diabetes, Heart condition, artificial joint, etc.) .

Date of your most recent COVID vaccine Just the month and year is fine

Safety Contact Info

If you will carry a cell phone on you during your trips, please provide that phone number

I understand this form will be kept in confidence by Andy Boos Outdoor Leader and will be referenced for any trips I take through 12/31/22.  I will inform him if any info needs to be updated.

Thanks for submitting-- You're good to go for 2022 trips.