Participation Releases

Acknowledgment of Risks/Acceptance of Responsibility

THIS FORM IS REQUIRED BY THE NATIONAL FOREST SERVICE AND BUREAU OF LAND MANAGEMENT

I recognize that there is a significant element of risk in any adventure, sport, or activity associated with the outdoors.  Knowing 

the inherent risks, dangers, and rigors involved in the Anasazi program activities, I certify that my family and myself, including my children, are fully capable of participating in the program activities.  I assume full responsibility for my family and myself, including any minor children, for bodily injury, death, loss of personal property, and expenses thereof, as a result of my negligence or of my family’s negligence.  I further understand that Anasazi reserves the right to refuse any person it judges to be incapable of meeting the rigors and requirements of participating in the program activities.  I have read, understand, and accept the terms and conditions stated herein and acknowledge that this agreement shall be effective and binding upon us during the entire period of participation in the Anasazi program activities.

Note: Your signature(s) confirms that you have been informed of Anasazi’s Program Description.  After a complete assessment (individual interview with Therapist and Nurse), an Individualized Master Treatment Plan will be reviewed with your family and YW in a shadowing session.

*The public may contact the Joint Commission’s Office of Quality Monitoring to report any concerns or register complaints about a Joint Commission’s Licensed Agency by either calling 800-994-6610 or emailing.