WAIVER FORM Page 2 of 2

Please print out, fill in and mail to:
Moon Mountain Adventures, 541 Pioneer Crescent, Parksville
British Columbia, Canada, V9P 1V1
Warning:     By signing this, you are waiving your legal rights and you give up the right to sue.

P L E A S E   R E A D    C A R E F U L L Y  Cont'd from Page 1

Mountain Flying:
Additional risks are posed by airplane and helicopter travel in mountainous areas, and in varying weather conditions.

Mountain Road Travel by Bus:
Additional risks are posed by bus or vehicle travel in mountainous areas, in vehicles and on roads that are not necessarily of North American standards.

Weather conditions may be extreme and can change rapidly without warning.

Whereas sanitation conditions may not be of North American standards, and bacteria and diseases can be prevalent, which do not pose a hazard in North America, participants may be exposed to a variety of conditions which can have a deleterious effect on their state of health.

We accept all the inherent risk of the above activities and the possibility of personal injury, death, property damage, or loss resulting therefrom. We agree that we will be fully responsible for all costs, and expenses, which may be incurred in providing any special services to us, outside of regular services agreed to or provided by Tom Carter in connection with the activities and without limiting the generality of the foregoing, we agree to be responsible for and to pay for all and any costs rescues, special travel, medical attention, or other special outlay for us personally and to reimburse Tom Carter for all costs of these services as may be incurred by him for our benefit or at our request.

We acknowledge that the enjoyment and excitement of this activity is derived in part from travel to and in mountains and other remote places and that the inherent risks of these activities to contribute to such enjoyment and excitment.

We confirm that we are the full age of majority, or alternatively, we have indicated that we are the guardians of the minor participant named and that we have read and understood this agreement prior to signing it and agree that this agreement will be binding upon our heirs, next of kin, executors, administrators and successors.

Signed, this _______ day of ______ 20____

Participant's Printed Name Participant's Signature or
Guardian's Signature if applicable
In the presence of:
Witness's signature
1._____________________ _____________________ _____________________
2._____________________ _____________________ _____________________

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