Mighty Midwest Camp presented by Pro Snowboarder Pat Milbery
at Raging Buffalo

EMERGENCY AUTHORIZATION: I, the undersigned parent or legal guardian of the above minor, or the above participant of legal age hereby authorize Avalanche Enterprises and its affiliates (“Raging Buffalo”) and/or the above-identified Emergency Contact/Chaperone to act as my agents in the capacity of activity supervisors and vehicle drivers, and to consent to medical, surgical or dental examination and /or treatment.

DISCLAIMER, ASSUMPTION OF RISK AND WAIVER: I, the undersigned parent or legal guardian of the above minor, for myself and on behalf of the above minor, our heirs, assigns and next of kin (“I”), acknowledge that participation in Raging Buffalo programs (including photo-shoots, snowboard camps, snowboard trips, wakeboard camps, wakeboard trips, wake surf camps, wake surf trips and other surf, skate, snow and similar events that Raging Buffalo may sponsor or in which Raging Buffalo athletes may compete) involves travel, participation in inherently dangerous activities (often in adverse conditions), physical contact and risk of severe, permanent physical injury including brain damage, nerve and spinal cord injury, paralysis and death. For myself, and on behalf of the above minor, our heirs, assigns and next of kin, we willingly and voluntarily accept and assume all such risk.

In consideration of accepting and permitting the voluntary participation of the above-named participant in Raging Buffalo programs, I hereby release, discharge and agree to hold harmless Raging Buffalo, its employees, volunteers, officials, sponsors and other representatives from any and all damages, claims, demands, costs, expenses and compensation arising out of or in any way related to any injury, physical or otherwise, or other damage that may result to said participant in connection with such program.

ACKNOWLEDGEMENT AND CONSENT: I acknowledge that Raging Buffalo may compile and use the name, likeness, recorded voice, addresses, photographs, film and videos of the named individual in advertising, marketing, product, packaging or other use, without compensation and without restriction as to duration, geography, media or frequency. I consent to such uses and hereby waive all rights to compensation.

I HAVE READ THE ABOVE EMERGENCY AUTHORIZATION, DISCLAIMER, ASSUMPTION OF RISK AND WAIVER, AND ACKNOWLEDGEMENT AND CONSENT AGREEMENTS, FULLY UNDERSTAND THE TERMS OF EACH, UNDERSTAND THAT I AND THE ABOVE PARTICIPANT HAVE GIVEN UP SUBSTANTIAL RIGHTS BY MY SIGNING THIS FORM AND AGREEING TO THESE TERMS, AND I SIGN THIS FORM AND AGREE TO THESE TERMS FREELY AND VOLUNTARILY AND WITHOUT INDUCEMENT FOR MYSELF AND ON BEHALF OF THE ABOVE PARTICIPANT.

Participant Signature: ______________________________________________  Date: _____________________

Parent Signature: _________________________________________________  Date: _____________________
(if participant is a minor under the age of 18)