**This information is for those permit holders who require clients to
sign Acknowledgement of Risk (Waivers of Liability)** **Forms.**

**[Acknowledgement of Risk (Waivers of Liability)]{.underline}** -- NPS
policy states that operators cannot require visitors (clients) to waive
their right to hold Commercial Use Authorization (CUA) or Special Use
Permit (SUP) holders responsible for actions.

1.  The Holder **is not** permitted to require clients to sign a waiver
    of liability statement or form, insurance disclaimer and/or
    indemnification agreement.

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1.  The Holder is permitted to request or require clients to sign an
    acknowledgement of risk statement or form prior to participation.

2.  The Holder may require or request a client sign a form or statement
    indicating that the client has certain prerequisite skills that may
    be required to participate in the commercial activity.

3.  If the Holder uses an acknowledgement of risk form, a current copy
    of the form must be sent to the Office of Special Park Uses for
    written approval prior to issuance of the CUA or SUP. A CUA or SUP
    will not be approved if the Acknowledgement of Risk for is not
    approved by the park.

> An editable copy of the National Park Service recommended
> Acknowledgement of Risk format can be downloaded at
> [www.nps.gov/yose/permits](http://www.nps.gov/yose/permits) . You may
> use this form to add your information in the appropriate spaces,
> however, please do not change the document text, as this will delay
> the approval of your permit while the form is reviewed.
>
> If you have questions regarding this information please contact
> <Ruth_Middlecamp@nps.gov> in the Office of Special Park Uses
> (209-379-1851).

**VISITOR'S ACKNOWLEDGEMENT OF RISKS**

In consideration of the services of \_\_\_\_\_\_\_\_\_\_\_\_ their
officers, agents, employees, and stockholders, and all other persons or
entities associated with those businesses (hereinafter collectively
referred to as "\_\_\_\_\_") I agree as follows:

Although \_\_\_\_\_\_\_\_\_\_\_\_ has taken reasonable steps to provide
me with appropriate equipment and skilled guides so I can enjoy an
activity for which I may not be skilled, \_\_\_\_\_\_\_\_\_\_\_\_ has
informed me this activity is not without risk. Certain risks are
inherent in each activity and cannot be eliminated without destroying
the unique character of the activity. These inherent risks are some of
the same elements that contribute to the unique character of this
activity and can be the cause of loss or damage to my equipment, or
accidental injury, illness, or in extreme cases, permanent trauma or
death. \_\_\_\_\_\_\_\_\_\_\_\_ does not want to frighten me or reduce
my enthusiasm for this activity, but believes it is important for me to
know in advance what to expect and to be informed of the inherent risks.
The following describes some, but not all, of those risks.

\[description of risks\]

I am aware that \_\_\_\_\_\_\_\_\_\_\_\_ entails risks of injury or
death to any participant. I understand the description of these inherent
risks is not complete and that other unknown or unanticipated inherent
risks may result in injury or death. I agree to assume and accept full
responsibility for the inherent risks identified herein and those
inherent risks not specifically identified. My participation in this
activity is purely voluntary, no one is forcing me to participate, and I
elect to participate in spite of and with full knowledge of the inherent
risks.

I acknowledge that engaging in this activity may require a degree of
skill and knowledge different than other activities and that I have
responsibilities as a participant. I acknowledge that the staff of
\_\_\_\_\_\_\_\_\_\_\_\_ has been available to more fully explain to me
the nature and physical demands of this activity and the inherent risks,
hazards, and dangers associated with this activity.

I certify that I am fully capable of participating in this activity.
Therefore, I assume and accept full responsibility for myself, including
all minor children in my care, custody, and control, for bodily injury,
death or loss of personal property and expenses as a result of those
inherent risks and dangers identified herein and those inherent risks
and dangers not specifically identified, and as a result of my
negligence in participating in this activity.

I have carefully read, clearly understood and accepted the terms and
conditions stated herein and acknowledge that this agreement shall be
effective and binding upon myself, my heirs, assigns, personal
representative and estate and for all members of my family, including
minor children.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Signature Date

Signature of Parent of Guardian, if participant is under 18 years of age

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Signature Date