Waiver Form Release during your Extreme Adventures in your Adirondack Camps

EXTREME ADVENTURES LIABILITY WAIVER

Waiver Form

(Each guest is required to read and sign before staying at Back to Basics)

Back to Basics

108 Rhinehart Road, Gloversville, NY 12078

RELEASE OF LIABILITY, WAIVER OF CLAIMS, ASSUMPTION OF RISKS AND

INDEMNITY AGREEMENT. PLEASE READ CAREFULLY, BY SIGNING THIS

DOCUMENT YOU WILL WAIVE CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT

TO SUE.

TO: Back to Basics representatives

(all of whom are collectively referred to as “Back to Basics”).

I AM AWARE that my participation on any activity at Back To Basics involves exposure

to RISKS, DANGERS and HAZARDS which may be greater or different than those I

normally encounter. Such RISKS, DANGERS and HAZARDS include but are not

limited to: travel and survival in the wilderness; inadequate physical fitness or endurance;

the use of defective equipment; changing weather conditions; varying environmental

conditions; varying wilderness conditions; encounters with and attacks by wild animals;

negligence on the part of Back To Basics; negligence on the part of fellow guests.

Use of woodstoves, propane appliances and other equipment provided.

I AM FURTHER AWARE THAT I may be exposed to RISKS, DANGERS, and HAZARDS

other than those listed above.

I FREELY ACCEPT AND FULLY ASSUME all and any such RISKS, DANGERS and

HAZARDS and the possibility of PERSONAL INJURY, DEATH, PROPERTY DAMAGE

or LOSS resulting from such RISKS, DANGERS, and HAZARDS.

I AGREE TO COMPLY WITH THE DIRECTIONS and INSTRUCTIONS of Back To Basics

before and throughout the stay.

IN CONSIDERATION of Back to Basics accepting my application and permitting my stay,

I HEREBY AGREE as follows:

TO ASSUME AND ACCEPT ALL AND ANY RISKS, DANGERS and HAZARDS arising out

of, incidental to, or in any way connected with my stay;

TO WAIVE ANY AND ALL CLAIMS, ACTIONS, COSTS, EXPENSES AND DEMANDS

that I may have against Back to Basics;

TO RELEASE Back to Basics from any and all liability for any LOSS, DAMAGE, INJURY,

or EXPENSE that I, or my next of kin, may suffer or incur as a result of my stay, due to any

cause whatsoever, including negligence on the part of Back To Basics;

TO HOLD HARMLESS AND INDEMNIFY Back to Basics from any and all liability for

property damage, personal injury or death suffered by myself or by a third party as a result

of my participation on the trip;

TO OBEY ALL DIRECTIONS AND INSTRUCTIONS from Back to Basics before and

throughout the trip;

THAT MY LEVEL OF PHYSICAL FITNESS AND ENDURANCE IS ADEQUATE for any

activities that I may participate in during my stay; THAT THIS RELEASE AND INDEMNITY AGREEMENT SHALL BE EFFECTIVE AND BINDING upon my heirs, next of kin, executors, administrators, and assigns, in the event of my death. To be fully responsible for any damage

to the facilities beyond normal wear and tear, and reimburse Back To Basics for reasonable

costs to repair such damage. To leave the lodging facilities in a clean state, comparable to the condition in which it was provided upon arrival.

I have read and understood this release and indemnity agreement prior to signing. I am aware

that by signing below, I am affecting my legal rights and liabilities and the legal rights and

liabilities of my heirs, next of kin, executors, administrators and assigns in relation to

Back to Basics.

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Name (Print)

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Signature Date