Wild and Free ~ 6-8 September 2024 Name * First Name Last Name Email * Home Address Mobile number * Emergency contact name and number * Boot Size (EUR) Size Chart - https://alpinerecreation.com/images/general/boot_size_comparison.png Dietary requirements Medical conditions / relevant injuries / allergies Do you suffer from any other medical condition(s) which might affect your ability to participate in this trip? eg. any recurring sports injury? Are you taking any medication? Back-country experience (hiking/backpacking? on trail/off trail?) Intention for attending this event Please share a memory of when you felt 'wild and free' (please note this memory will be shared in the safe space of the retreat) I agree to the payment terms: * To ensure your place on this retreat please pay $250 non-refundable deposit into account 'Tekapo Wellness' 03-1599-0202761-00 upon registration. The full retreat payment of $1,000 is due 21 days prior to the event. No refunds are given thereafter. I agree I agree to voluntary assumption of risk for Tekapo Wellness / Alpine Recreation * While we endeavour to guide you safely through the events activities, it is important you realise there are risks involved in any activity. Please work at your own level and explore your own limits. Use your own discretion to not go beyond personal physical boundaries. Please inform us of any pre-existing acute or serious health conditions that may limit your involvement in any activity. If you have any concerns regarding your fitness level, ability or skill to undertake an activity it is recommended you seek the appropriate independent advice (including medical). Alpine Recreation requires every person who participates in one of the company's trips to acknowledge the inherent dangers and risks in the activity being undertaken. Because you will be entering a natural environment, where there are many natural hazards ranging from weather to avalanches, there is no guarantee that Alpine Recreation can entirely eliminate all risk resulting from your exposure to those hazards. However, guides and management will use a high degree of skill to mitigate, minimise and avoid those risks, to ensure the safety and welfare of participants. Alpine Recreation Canterbury Ltd. will not accept liability for loss, injury or damage sustained by a participant or his/her dependents in circumstances where the likelihood of occurrence AND the consequences of a natural hazard or other event was difficult to predict, or avoid by the exercise of reasonable care. Alpine Recreation reserves the right to withdraw any person who in their opinion is likely to endanger themselves or others. This exclusion includes the overuse of alcohol and/or recreational drugs. Please see the full Risk Disclosure Agreement here: https://www.alpinerecreation.com/risk-disclosure.html By checking the I agree box you are agreeing to assume responsibility for the risk's incidental to participation in this event. I agree Insurance You may wish to consider travel insurance to cover yourself in case you have to cancel at short notice due to injury, illness of yourself or a close family member. Southern Cross has a good domestic travel insurance with cover just from $34. See https://www.scti.co.nz/our-policies/domestic/insurance-cover. The New Zealand Alpine Club has a good comprehensive insurance to cover adventure activities: https://alpineclub.org.nz. NZ residents can also take out Loss of Deposits Insurance with them. I agree to the photography and filming waiver From time to time photos and videos may be taken during the event. We endeavour to limit the intrustion into our soulful space. These may be used for marketing future events. We will not use any photos or videos that are identifiable to you, without prior permission. By checking the 'I agree' box, you agree to the terms and conditions of this waiver. I agree Thank you!