WAIVER FORM Page 1 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 To: Tom Carter, Moon Mountain Adventures PARTICIPANT(S) NAME(S):__________________________ ACTIVITY:________________________ Please print name of activity. We desire to participate in the above activities organised by Tom Carter. We understand that in order for Tom Carter to accept our application to participate in the above activities, we must agree to be bound by this Release Waiver and Assumption of Risk. In consideration of Tom Carter accepting our application and our being permitted to participate in the above activities, we must agree to this Release and Assumption of Risk. We waive any and all claims we may now and in the future have against, and release from all liability, and agree not to sue Tom Carter, his family, or his estate or his staff, for any personal injury, death, and property damages, expenses or loss sustained by us, as a result of our participation in the above activities, due to any cause whatsoever, including without limitations, negligence or breach of duty. In addition to the usual dangers and risks inherent in travel to and in mountains and other remote places, we are aware the above activities may have certain additional risks and dangers, some of which include: Mountain Terrain: The mountainous areas used for the above activities, organised by Tom Carter, have steep slopes, which in their natural state have hazards which may be hidden by snow in winter or foliage in summer. They include loose rock, glacier crevasses, ice and snow cornices, creeks, forest deadfalls, and varying and difficult conditions. There may also be man-made hazards including roads of low standards, trails of poor standards, and shelters of poor standards. Washouts are common in the monsoon season. Because of rugged terrain or bad weather, participants may become lost or separated from their guides or companions. Communication in this terrain is always difficult and in the event of an accident, rescue and medical treatment may not be available. Avalanches and Rockfalls: Avalanches can occur frequently in mountain terrain. They may be caused by a variety of natural forces including steepness of slope, snow depth, instability of the snow pack or changing weather conditions. Participants can be overcome by rockfall at any time without warning. The actions of other participants can trigger the avalanche or rockfall. Please continue on Page 2 of Waiver Form