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FORMS

After registering for one of our programs, please submit the following forms for every individual attending the program:

GROUP RETREATS

- RMA Release

- Health History 

- Group Retreat Customization Form (1 per group)

SUMMER CAMPS

- RMA Release

- Health History

*If you have your own documents of the following, you can submit those. If not, you can use our templates linked at the bottom of the page. Please attach and submit forms at the end of the Health History Form below (preferred), or email to yourfriends@rmascent.org*

- Immunization Records

- Physician Exam

RMA Release

Liability Release

Understanding that any physical activity involves the risk of increased heart rate, injury and/or death, I understand that my participation in programs with Rocky Mountain Ascent (RMA) is entirely voluntary. I understand that RMA does programs indoors as well as in outdoor settings. During events held outdoors I will be in an environment with natural occurrences and results such as sudden weather changes, insects, animals, uneven and wet ground conditions. I understand it is my responsibility to inform RMA staff of any, and all physical limitations, liabilities or injuries I possess, including, but not limited to neck, back, and heart problems, recent surgeries or pregnancy. My family and I release Rocky Mountain Ascent, its board, mentors and other agents from any claims or liability arising out of my participation in any activities to include but not limited to: rock climbing, kayaking, horseback riding, fishing, canoeing, hiking, mountaineering, swimming, inner tubing, archery, riflery, camp fires, white water rafting and high ropes challenge course. This waiver, release and discharge from liability include releasing said Entity and persons from liability for its or their own negligence. I indemnify and hold harmless Rocky Mountain Ascent and the persons mentioned above from any and all liabilities or claims made by other individuals or entities as a result of any of my actions during the event.

Consent for Medical Treatment

Signature of participant and/or parent or legal guardian indicates an understanding of the above information and a release to treat, in the event of a medical emergency.

 

Consent to Transport

Signature of participant and/or parent or legal guardian indicates release to transport participant to and from camp activities in accordance with the transportation guidelines established by Rocky Mountain Ascent as published in the operating procedures guide.

Photo Release

Signature of participant and/or parent or legal guardian authorizes the use and reproduction by Rocky Mountain Ascent, of any photographs, videotape and sound recordings taken of them during this program for media and marketing use.

Consent to Contact/Communicate

I hereby authorize the Rocky Mountain Ascent Staff to communicate with my camper. The best method of communication is: (Leave blank if you do not consent to staff communicating directly with your camper).

RMA Health History/Medical Release

In case of emergency, notify the person below:

Health History:

Please check the box if have or have you ever been treated for any of the following
Are you allergic to or do you have any adverse reaction to any of the following:
Will your camper require disability-related accommodations? (Must be arranged at least one week prior to camp start date. Reach out to yourfriends@rmascent.org to request accommodations.

List all medications currently prescribed (Required):

Do you authorize camp staff to administer non-prescription medications to your camper (Tylenol, Motrin, Cold Medicine, etc.)
Do you authorize our camp medical staff to provide emergent or urgent care and administer prescription medication?

Sunscreen/Bug Spray:

Do you authorize the RMA staff to put sunscreen on your child:
Does your child have any sensitivity or allergy to sunscreen:
Do you authorize the RMA staff to put bug spray on your child:
Does your child have any sensitivity or allergy to bug spray:
Upload PDF
Upload Image

Group Retreat Customization Form

*This form is only for those who have already registered for a group retreat*

Choose your activities! Your total should add up around 8 hrs per day. (A 2-day retreat is 16 hrs, a 3-day is 24 hrs, a 4-day is 32 hrs)

*It does not have to be exact, you're welcome to request more than 8hrs per day. This is a request of activities, so no activities are guaranteed*

Adventure
Choose Your Accommodations
Wellness
Do you require transportation? (11 passengers max)

Downloadable Forms

If you cannot submit forms electronically, please download the forms below and email them to yourfriends@rmascent.org. Please title them First.Last_HealthHistory or First.Last_Release. Thank you! 

HEALTH HISTORY

RELEASE

IMMUNIZATIONS

PHYSICIAN 
EXAM

INFO PACKET

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