Participant Online Forms 1Participant Information2Parent/Guardian Information3Guidelines for Participation4Media Release Statement5Release and Acknowledgement Agreement6COVID-197Emergency Contact and Medical Information Please indicate who is completing this form:* Participant Parent/Guardian Parent/Guardian's Name* First Last Participant's Name* First Last Please select participants current status:* UConn Undergraduate Student UConn Graduate Student UConn Staff/Faculty UConn Alumni Not Affiliated with UConn NetID* Are you 18 years old or older?* Yes No Date of Birth* MM slash DD slash YYYY Parent/Gurdian's Cell PhoneParticipant's Cell PhoneParent/Guardian's Email* Participant's Email* Group Name* Program ID # (If known please provide)Program Date (if known) MM slash DD slash YYYY Earlier you indicated that you are under eighteen years of age. As a result you will need to have a parent or legal guardian complete an online version or paper version of the Guidelines for Participation, Media Release Statement, Release and Acknowledgement of Risk, and Emergency Contact and Medical Information forms on your behalf. If you enter their name and email address below they will be sent an email asking them to complete this online form. By providing the information below you give the Department of Student Activities permission to contact (email) the parent/guardian listed below and request that they complete the online forms on your behalf. It is also recommended that you contact them directly to ensure that they have received the request and have completed the form. In addition to having your parent/guardian complete the online forms, we still would like you to finish the remaining pages of this form to better understand what we ask of our participants.Parent/Guardian Information* First Last Parent/Guardian Email* (Note: this email will be used to request that your parent/guardian complete the online forms on your behalf) GUIDELINES FOR FOUR ARROWS PARTICIPANT There are a few things you need to prepare for... DRESS Dress appropriately for potential indoor and outdoor activity. This includes proper layering for the weather forecast during your program. If it rains or snows lightly, we may still be outside. Strong possibility of being in the woods for a period of the program. MUST WEAR sturdy, close-toed shoes, sneakers, or boots with socks - REQUIRED. Long hair should be tied back. NO perfume or scented lotions. NO cell phones, necklaces, bracelets, dangling or hoop earrings, rings or watches...leave them all in a safe place.SUPPLIES Programs may include both time in open areas and in the trees. Unscented sunscreen and bug spray recommended. Water bottle (make sure your name is on it or it can be identified as yours). Small snack for yourself is suggested. A form of ID (driver's license or student ID). For UConn faculty/staff and other non-UConn participants: Insurance Card or information (in case of emergency) PARTICIPATION Four Arrows programs are an adventure. Come prepared with an attitude and an appetite for the exciting, the new, the ambiguous, and the profound. Leave your troubles behind, bring an open mind, and get ready for a great experience. Physical contact during a program is inevitable & vital to the program. We use the model “Challenge by Choice.” You are not required to do anything if you feel it poses extreme physical or psychological stress to you; you will be challenged to go beyond your comfort zone and to take new risks. Because of safety risks inherent in an adventure program, you must follow the directions of your facilitators at all times. Participants who are not following the direction of the facilitator or who are creating an unsafe environment may jeopardize their participation in the activity. ADDITIONAL INFORMATIONEach facilitator carries a First Aid kit and supplies. Our main facilities are located at 14 Sherman Place, Storrs, CT 06269 on Depot Campus. More information can be found at www.FourArrows.UConn.edu Those facilities contain a large fridge and space to keep personal items while participating in your program. Your group leader will be able to provide you with logistics and other details about your program. Electronic Signature* Please type your First and Last NameYour Initials* Date* MM slash DD slash YYYY * I understand that checking this box constitutes a legal signature confirming that I acknowledge that I have read these guidelines and agree to the above terms and conditions * Since I indicated that I was under the age of 18, I understand that a parent or guardian must complete this form physically or electronically to be able to participate in this experience and I acknowledge that I have read these guidelines. MEDIA RELEASE STATEMENT Four Arrows periodically uses electronic and traditional media for publicity, educational, or advertising purposes. By indicating my stance and providing my signature on this form, I acknowledge receipt of this document and deny or give permission to Four Arrows and its agents to use such reproductions of my person in any and all forms of media for educational, publicity, or advertising purposes in perpetuity without further consideration from me. I understand that this release is a limited release of any confidentiality rights I may have under the Family Educational Rights and Privacy Act. If I give permission to gather media, I hereby waive any right to inspect or approve the finished photographs or printed or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown, and I waive any right to royalties or other compensation arising from or related to the use of the photograph. I understand that I will need to notify Four Arrows if any changes to my situation occur that will impact this media release permission. Please Choose One Option:* Yes, I Give Permission No, I Deny Permission Electronic Signature* Please type your First and Last NameYour Initials* Date* MM slash DD slash YYYY * I understand that checking this box constitutes a legal signature confirming that I acknowledge that I have read and agree to the above terms and conditions * Since I indicated that I was under the age of 18, I understand that a parent or guardian must complete this form physically or electronically to be able to participate in this experience. RISK AND SAFETY: RELEASE AND ACKNOWLEDGEMENT AGREEMENT Experiential activities are exciting, challenging, and both physically and mentally demanding. This program provides goal-oriented activities that offer participants an opportunity to explore new behaviors related to trust, teamwork, and leadership capabilities. These activities may include field games, low elements and initiatives that may take place a few feet off the ground and that are constructed with rope, cable, and wood. These activities are supervised by individuals who have been specifically trained in the effective facilitation and relevant safety practices. Individual participants are not required to participate in any activities, however they are/will be encouraged throughout the experience to challenge themselves, physically and mentally, to achieve the goals of the activities. The University has taken all reasonable precautions to provide proper equipment and qualified instructors. All activities are supervised throughout the program. Instruction will be provided regarding the safe use of all elements and activities. Participants are advised to point out hazardous situations to the facilitators. However, it is impossible to guarantee absolute safety in adventure activities. Risks may include, but are not limited to the following: 1. minor injuries such as scratches and bruises that may result from rubbing against equipment, falling against equipment, or falling on the group; 2. major injuries such as broken bones or eye, back, or head injuries that may result from falling from equipment, group members landing on the group, or improper use of the equipment; 3. catastrophic injuries such as paralysis and death that may result from falling from equipment or improper use of equipment; and 4. property damage or loss. In consideration for being permitted to participate in a Four Arrows Program at the University of Connecticut, I hereby assume all responsibility and risks related to my participation, as partially outlined above. I understand that participation in the activity carries with it risks that cannot be eliminated. To the extent permitted by law, I understand and acknowledge that the University of Connecticut, its governing board, the State of Connecticut and their officers, employees, agents, representatives, successors and assigns (collectively the “University”) assume no liability for property damage or personal injuries to me or third persons arising out of participation in the Four Arrows Program. I agree to indemnify and to save the University harmless from any liability arising out of my acts or omissions during the activity. I have arranged, through insurance or otherwise, to cover any medical costs that may arise or be associated with my participation in the Four Arrows Program. I recognize that the University is not obligated to attend to any of my medical or medication needs, and I assume all risk and responsibility therefore. If I require medical treatment or hospital care during the Four Arrows Program, I agree that the University is not responsible for the provision, cost or quality of such treatment or care.I further acknowledge that I am at least 18 years of age and fully competent to sign this Agreement, and that I execute this Release for full, adequate, and complete consideration, fully intending to be bound by it. I execute this document in consideration for the University of Connecticut allowing my participation in this Four Arrows Program, and with full knowledge of the contents and consequences of it. I further agree that this Release shall be construed in accordance with the laws of the State of Connecticut. If any term of this Release is determined to be illegal, unenforceable, or in conflict with any law, the validity of the remaining portions will not be affected thereby.I further acknowledge that I am under 18 years of age and require an additional signature by my Parent/Guardian for the Release. To my knowledge I am fully competent to sign this Agreement, and that I execute this Release for full, adequate, and complete consideration, fully intending to be bound by it. I execute this document in consideration for the University of Connecticut allowing my participation in this Four Arrows Program, and with full knowledge of the contents and consequences of it. I further agree that this Release shall be construed in accordance with the laws of the State of Connecticut. If any term of this Release is determined to be illegal, unenforceable, or in conflict with any law, the validity of the remaining portions will not be affected thereby.Electronic Signature* Please type your First and Last NameYour Initials* Date* MM slash DD slash YYYY I understand that checking this box constitutes a legal signature confirming that I acknowledge that I have read and agree to the above terms and conditions Since I indicated that I was under the age of 18, I understand that a parent or guardian must complete this form physically or electronically to be able to participate in this experience. COVID-19 Response and Requirements Four Arrows has carefully developed protocols and strategies in regards to COVID-19 at our site of operations. We ask that you take the time to review the detailed outlines of requirements of groups/participants. We require all participants and staff to wear proper face coverings while on site and during all programming with Four Arrows. We will require you to maintain 6 feet of distance between others. We may ask you to wash or sanitize your hands before and after doing certain adventure activities. We will have hand sanitizer available on site but recommend each individual bring a personal bottle for themselves . Participants coming to Four Arrows must ensure that they are not showing any COVID-19 symptoms. Any individual who may be sick, or may have had contact with anyone who is sick, is to refrain from coming to our site. Four Arrows staff reserve the right to ask any individual to leave the site if exhibiting COVID-19 symptoms or not able/not willing to follow Four Arrows protocols. COVID-19 Symptoms Cough (excluding chronic cough due to known medical condition) Shortness of breath of difficulty breathing Two or more of the following symptoms: Fever of 100.4 or greater Chills Repeated shaking with chills Muscle pain Headache Sore throat New loss of taste or smell Electronic Signature* Please type your First and Last NameYour Initials* Date* MM slash DD slash YYYY I understand that checking this box constitutes a legal signature confirming that I acknowledge that I have read and agree to the above terms and conditions Since I indicated that I was under the age of 18, I understand that a parent or guardian must complete this form physically or electronically to be able to participate in this experience. All emergency contact information will be stored on a secure server that requires password protected login credentials to access. None of this information will be transferred directly over e-mail and will only be utilized in case of emergency. Allergies, injuries, and other relevant pieces of information about the participant will be taken into consideration in our program planning.Emergency Contact's Name* First Last Emergency Contact's Relationship* Emergency Contact's Address* Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Emergency Contact's Day Time Phone*Emergency Contact's Evening/Weekend Phone*Emergency Contact's Day Time Phone*Emergency Contact's Evening/Weekend Phone*Possible Medical Implications of participant's ability to take part in program and/or pertinent information in case of emergency (check all that apply)* Allergies Medication Current Injury Prior Conditions Physical Limitation Mental Limitation Other None of the Above Based on what was checked please provide specific details about your medical implications*Electronic Signature* Please type your First and Last NameYour Initials* Date* MM slash DD slash YYYY * I acknowledge that I am releasing this information for the disclosure to and only to University Officials to provide to appropriate medical officials in the event of an emergency. * Since I indicated that I was under the age of 18, I understand that a parent or guardian must complete this form physically or electronically to be able to participate in this experience and I acknowledge the information provided is only to be disclosed to University Officials to provide to appropriate medical officials in the event of an emergency. 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