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Are you ready to live an extraordinary adventure?

Our address

600, rang St-Placide Nord,
Baie St Paul, Québec
Phone: (00-1) 418 435 2114
Email: contact@traineauchien.com

La Reine et le MIllionnaire

ACKNOWLEDGEMENT
AND ASSUMPTION OF RISK




1) RISKS INHERENT TO THE ACTIVITY

The risks inherent to the activity in which I will participate are, in particular, but not limited to the dog sledding activity

  • Injuries due to falls or other movements, (sprain, strain, fracture, etc.);
  • Injuries with blunt or sharp object (branches, material, etc.);
  • Cold or hypothermia;
  • Injuries resulting from accidental or other contact between individuals;
  • Food allergy;
  • Contact with water or drowning (during water activities or near a watercourse);
  • Burns and/or other heat induced injuries.

2) HEALTH PROFILE

Allergies ? YESNO
Are you pregnant ? YESNO
Are you on medications? YESNO
Do you have physical, emotional or behavioural problems that could limit your participation in your chosen activity? Specify (ex. respiratory and/or
cardiac problems, diabetes, vision or hearing problems, fear of water / heights / dogs, limitation of movements, etc.) YESNO

NB: If you have answered YES to any of the questions in section 2, YOU HAVE TO NOTIFY THE GUIDE BEFOREHAND. Having discussed my medi-
cal condition with a person in charge at La Reine et le Millionnaire, I agree and accept the additional risk that my health condition may be aggravat-
ed by participating in the activity.

3) CONFIRMATION OF INFORMATION AND ASSUMPTION OF RISKS

I hereby certify that the information consigned to this Registration Card is, to the best of my knowledge, exact and accurate. I further certify that
no information pertinent or not to my health profile was deliberately omitted. I am aware that the information contained in this Registration Card is confidential and will be used to better plan and supervise the safety of the activities in which I will participate and will allow La Reine et le Million-naire to draw up a profile of its clientele. I am also aware that the activities offered by La Reine et le Millionnaire take place in semi-wild or natural environments that, consequently, are quite distant from medical services. This state of affairs could result in long delays during an emergency requiring an evacuation and, as such, a possible aggravation of my state of health or my injury. Having taken cognizance of these risks and having had the opportunity to discuss them with a person responsible for the activity, I acknowledge that I was informed about the risks inherent to the
activities and I am able to participate in the activity or the stay WILLINGLY AND I ACCEPT ANY AND ALL RISKS THAT such an activity or stay can
comprise. I also pledge to play an active role in risk management by adopting a preventive behaviour with regards to my own safety, and the safety
of the other persons that surround me. The guide reserves the right to exclude any person he/she deems to be a risk to himself/herself or to the
rest of the group. I understand that I may leave the present activity for any reason whatsoever.

4) DRUGS AND ALCOHOL

I promise to not consume, not have in possession, or be under the influence of any drugs (prescription or otherwise) or ille-gal substances which are not mentioned in point 2 of this form. I also confirm to not be under the influence of alcohol (below the limit of 80 mg alcohol per 100 ml of blood, commonly called “zero point eight”), and remain so for the entire duration (activ-ity / trip / stay). I am aware that any violation of these rules on my part might evict me from the activity/ trip/ stay without no-tice and without refund.

NAME OF PARTICIPANT (BLOC LETTERS):


MATERIAL LIABILITY WAIVER

I, undersigned, forego to any claim, proceeding in damage or interest for damages to assets and material of my belonging (attrition, loss, breakage, theft, vandalism).



AUTHORIZATION IN CASE OF EMERGENCY

Adult

I, undersigned, authorize La Reine et le Millionnaire to provide all necessary care. I also authorize La Reine et le Millionnaire to take
decision in case of an accident to transport me (by ambulance, helicopter, coast guard or other) to a hospital or health care center,
and this, at my own expense.