I (print name)_________________________ acknowledge that participating in the
activities offered by Alaska Big Nugget Adventures LLC carries a degree of risk.
I am aware that recreational activities of metal detecting, prospecting, mining
and residing at Alaska Big Nugget Adventures properties in remote wilderness
Alaska has inherent risks, hazards and dangers that cannot be eliminated. They
include but are not limited to:
1. Water hazards from wading, swiming, mining or boating in streams, rivers
and ponds, including drowning.
2. Walking in rugged country without improved roads and trails.
3. Encounters with wildlife.
4. Inclement weather conditions.
5. Injury from operating mining equipment.
6. Injury from riding an All-Terrain Vehicle (ATV), motor scooters or any vehicle
used to transport people or equipment.
7. Firearms and being in the vicinity of others who have firearms in their possession.
8. Physical exertion needed to participate in prospecting and gold mining.
9. The lack of immediate medical care in case of an injury or sickness.
10. Burns caused by fire, hot liquids or food.
11. The long distance from Alaska Big Nugget Adventures LLC camp and properties
to any emergency assistance.
I understand and accept the risks, hazards, and dangers as described above. I know that these activities may require being in good physical condition and a degree of skill and knowledge. I am in good physical condition and have the knowledge necessary for me to engage in these activities safely. I understand that my participation in this activity is purely voluntary. I elect to participate in spite of the risks. I AM VOLUNTARILY METAL DETECTING, PROSPECTING AND RECREATIONAL GOLD MINING WITH ALASKA BIG NUGGET ADVENTURES LLC WITH FULL KNOWLEDGE OF THE INHERENT RISKS, HAZARDS, AND DANGERS INVOLVED AND HEREBY ASSUME AND ACCEPT ANY AND ALL RISKS OF INJURY, PARALYSIS OR DEATH.
By signing this document I, for myself, my heirs, successors, executors, and subrogees, hereby KNOWINGLY AND INTENTIONALLY WAVE AND RELEASE INDEMNITY AND HOLD HARMLESS ALASKA BIG NUGGET ADVENTURES LLC, their directors, officers, agents, employees and volunteers from and against any and all claims, actions, causes of action, liabilities, suits, expenses including any attorneys’ fees which are related to, arise out of, or are in any way connected with my participation in this activity including, but not limited to NEGLIGENCE of any kind or nature, whether foreseen or unforeseen, resulting, directly or indirectly, in injury, paralysis, or death to me or damage to or loss of my property as a result of my engaging in these activities or the use of these services, or equipment, whether such damage, loss, injury, paralysis or death results from negligence of Alaska Big Nugget Adventures LLC or from some other cause. I, for myself, my heirs, my successors, executors and subrogees, further agree not to sue Alaska Big Nugget Adventures LLC as a result of any injury, paralysis, or death suffered in connection with my use equipment or facilities provided by Alaska Big Nugget Adventures LLC and participation in the activities of metal detecting, prospecting and recreational gold mining.
My signature on this document authorizes Alaska Big Nugget Adventures LLC personnel
to act for me according to their best judgment in any emergency requiring medical
attention. I understand that I may be transported by Alaska Big Nugget Adventures
LLC or other third party personnel to medical facilities. I hereby waive and
release Alaska Big Nugget Adventures LLC from any and all liability for any
injuries or illnesses incurred while participating in the actives of, residing
with or while being transported by Alaska Big Nugget Adventures LLC. I have
no knowledge of any physical or mental impairment that would be affected by
or prevent my safe participation in any activity at Alaska Big Nugget Adventures
LLC mining camp or properties. I further acknowledge that any expenses for medical
treatment or emergency transportation incurred on my behalf will be the responsibility
of myself, my estate and/or my family.
This Liability Waiver and Medical Release is intended to be as broad and inclusive as is permitted by Alaska Law. If any part or provision of this waiver and release is held to be invalid or legally unenforceable for any reason, the remainder of this Waiver and Release shall not be affected thereby and shall remain valid and fully enforceable. I further agree that the venue for any legal proceeding shall be in Anchorage Alaska.
I HAVE CAREFULLY READ, CLEARLY UNDERSTAND, AND VOLUNTARILY SIGN THIS LIABILITY WAIVER AND MEDICAL RELEASE AGREEMENT.
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Signature
Date
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Print Name
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Witness
Signature
Witness Name (Print)
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Mailing Address
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City State Zip
Home Phone: ( )______________ Cell: ( )___________ E-mail:________________________
EMERGENCY INFORMATION
Emergency Contact Name:______________________________________
Emergency Contact Phone: ( )_________________________________
Insurance Information
Insurance Company:_________________________Phone: ( )___________
Physician Name: ____________________________Phone: ( )___________
Additional information a treating physician should know regarding allergies, medications taken, etc. should you be unable to provide this information at the time of treatment please note here: _____________________________________________________________________________________________
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