Trip Release Forms

1PARTICIPANT ENROLLMENT FORM

2ADULT HOLD HARMLESS AGREEMENT

3MEDIA RELEASE

Participant Enrollment Form

Part 1 of 3
Welcome to the participant enrollment for our fly-fishing outings. In this enrollment process, we require some basic information from you in order to know what outing will best suit your needs along with knowing how to maintain contact with you as the trip planning cycle begins. For all of our fly-fishing outing trips, there is absolutely no cost to you in participating. We take care of transportation, meals, lodging, fly-fishing equipment (rod/reel, flies, tippet, etc.) and seek to maintain a 1:1 or 1:2 between the experienced guide and the participant. Our fly-fishing outings normally start in mid-June and run through September each year. It is our intent to notify a participant of their selection to participate at least 30 days prior to the trip’s start date. Additionally, it is our intent to only have a participant on one trip per year in order to equitably serve all Veterans who desire to participate. We will maintain a standby list in order to ensure all trips are full. Within our fly-fishing outing program, we offer:
- Day trips to some local streams within the Helena surrounding area on both public and private land. These are wade/walk trips and the participant must be able to walk and wade without support.
- Float trips on the Blackfoot River utilizing fishing style rafts.
- 2-Day float trips on the Missouri River. This trip will utilize drift boats, lodging along the river and fishing river sections between Holter Dam and Cascade, MT.
- 2 ½ Day wade/walk trip to the Ruby River fishing within the area owned by the Ruby River Foundation (just south of Sheridan, MT).
- 2-Day Women’s only trip on the Missouri River. This trip will utilize drift boats, lodging along the river and fishing river sections between Holter Dam and Cascade, MT.
- Other trips as opportunities become available.
Please complete the below enrollment and Thank You for your interest in participating! All information provided will only be used for trip participation by Mending Waters Montana and will not be provided to any third party.
Name*
First Middle Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Emergency Contact Person and Phone Number*
First Name Last Name Phone Number
Question 1: Do you want to participate in a 1-Day wade/walk trip?
- Yes
- No
Question 2: Do you want to participate in the 2 ½ Day Ruby River wading trip?
- Yes
- No
Question 3: Do you want to participate in the 2-Day Missouri River drift boat trip?
- Yes
- No
Question 4: Do you want to participate in the Women’s only 2-Day Missouri River drift boat trip?
- Yes
- No
Question 5: Do you have any food allegories and/or special food consumption requirements?
- Yes
- No
More Infomation
Question 6: If all trips are currently full, do you want to be placed on a standby list?
- Yes
- No

Adult Hold Harmless Agreement

Part 2 of 3

RELEASE AGREEMENT

In consideration of the privilege granted me to participate in the Mending Waters Montana, Inc. programs (the “Programs”), I, the undersigned, in acknowledgment that I am doing so entirely upon my own initiative, risk and responsibility, do hereby, for myself, my heirs, executors, and administrators, agree to remise, fully release, hold harmless, and forever discharge Mending Waters Montana, Inc. and each of their officers, directors, employees and volunteers, acting officially or otherwise, jointly and severally from any and all claims, demands, actions or causes of actions, on account of my death or on account of any injury to me or my property which may occur from any cause whatsoever, including, without limitation, the negligence of any Releasee, or the consumption of alcohol by me or others, while participating, or as a result of my participation, in the Programs.

I fully understand the risks and dangers involved in fly fishing, particularly when wading or boating, and related fly fishing activities.

In the event of injury to me while participating in the Programs, I hereby authorize any of the Releasees to seek on my behalf any necessary medical attention.

If any term or other provision of this Release Agreement is determined by a court of competent jurisdiction to be invalid, illegal or incapable of being enforced by any rule of law or public policy, all other terms, provisions and conditions of this Release Agreement shall nevertheless remain in full force and effect.

I have read this Release Agreement and fully understand the consequences of this Release Agreement, including that it releases the Releasees from any and all liability on account of any injury to me or to my property. I further attest that I am over 18 years of age and possess the capacity to enter into this Release Agreement.

Participant Signature
Signature
Date*
MM slash DD slash YYYY

MEDIA RELEASE

Part 3 of 3

MENDING WATERS MONTANA, INC., [MWM] FORM OF CONSENT FOR USE OF PERSONAL INFORMATION AND VISUAL IMAGES MWM is a 501(c)(3) non-profit charitable organization registered with the State of Montana. Mending Waters Montana, Inc. is dedicated to the physical and emotional rehabilitation of active military service personnel and veterans through fly fishing and associated activities including education and outings.

Consent Form

In consideration of the opportunities and services offered by MWM and my participation in them, I agree to permit MWM to use pictures, photographs, and/or other visual images of me, and narrative material about me and my participation in the MWM programs, for its educational and promotional efforts and its website.

I assign all rights, title, and interest in and to the material and the copyright of the materials to MWM.

I waive any right to inspect and approve the photos, or other images and narrative materials about me, and any advertising and promotional copy with which they are connected. I understand that the circulation of such materials could be nationwide and that there will be no compensation to me for the use of such materials by MWM.

I waive any claim and all causes of action I may have against the MWM for its use of the pictures, photographs or visual images and narrative material.

The rights and protections granted in this document may be exercised by MWM at any time without limitation.

My participation in the programs of MWM is voluntary and in my private capacity.

I have read this document and intend to be bound by it.

Participant Signature
Signature
Date
MM slash DD slash YYYY

Volunteer

First Name	Last Name	Phone Number

Trip Release Forms

Participant Enrollment Form

Adult Hold Harmless Agreement

MEDIA RELEASE