RELEASE OF LIABILITY, WAIVER OF CLAIMS, ASSUMPTION OF RISKS, AND INDEMNITY
AGREEMENT FOR BCA COMPRESSED AIR CYLINDER REFILLS (“RELEASE”)
Shop: ______________________________ (“Shop”) Technician Name: __________________________
Date of Refill: _______Cylinder Head Serial Number/Date Code: ________Filled Pressure:___________
IMPORTANT! This is a legal document. Please read it carefully and understand its contents beforesigning.
1) I understand and agree that this Release shall cover the refilling of Backcountry Access, Inc. (“BCA”) Compressed Air
Cylinders, which are used with BCA Float Airbag Systems. (read and initial) _______2) I confirm that I fully understand how to use BCA Float Airbag Systems and further understand that the systems aredesigned to inflate by pulling their trigger handles. I agree to perform a full system check of my BCA Float Airbag Systembefore every backcountry outing. (read and initial) _______
3) I understand and agree that it is my responsibility to check the pressure gauge of my BCA Compressed Air Cylinderfourteen (14) days after the cylinder is refilled and in addition, prior to every use, verify that the gauge reads between
2500psi to 3000psi for 1.0 cylinders or 2800psi to 3300psi for 2.0 cylinders at room temperature.(read and initial) _______
4) I understand and agree that a BCA Float Airbag System, even when properly deployed and inflated, cannot prevent
burial or reduce burial depth in all cases, which may lead to injury or death, and that burial in an avalanche is an inherent
risk of travel in areas, terrain, or conditions that could be subject to avalanches. (read and initial) _______
5) I authorize the above-named Shop to perform such work that is necessary to properly fill, test, service, or repair myBCA Compressed Air Cylinder. (read and initial) _______
6) I accept the BCA Compressed Air Cylinder “AS IS” and with no warranties, express or implied, beyond those containedin this Release and in the manufacturer’s written limited warranty, if any. (read and initial) _______7) To the fullest extent allowed by law, I hereby agree to forever release, hold harmless, defend and indemnify the abovereferenced Shop and BCA, as well as their owners, agents, employees, and affiliated companies (collectively “Releases”),
from any and all responsibility, legal liability or costs or expenses (including attorneys’ fees and expenses) that I or myminor child(ren) have or may in the future have against the Releases related to any and all loss, damage, expense orinjury, including death, that I or my minor child(ren) may suffer, resulting from or arising out of any aspect of my or myminor child(ren)’s use of the BCA Compressed Air Cylinder( s ), due to any cause whatsoever, including negligence,
breach of contract, or breach of any statutory or other duty of care, with respect to refilling, testing, servicing, or repairing
the BCA Compressed Air Cylinder or with respect to the Releases’ failure to provide adequate warnings, directions, orinstructions as to the proper use of the BCA Compressed Air Cylinder or the risks, dangers, and hazards of avalanches.
(read and initial) _______8) I understand and agree that this Release is a legally binding contract which supersedes any other agreements by orbetween me and the Releases, and which constitutes the final and entire agreement regarding this transaction. This
Release is intended to provide a comprehensive release of all legal liability which is binding upon and for the benefit of all
Releases, but it is not intended to assert any claims or defenses that are prohibited by law. If any part of this Release isheld to be invalid or unenforceable, the remainder shall be given full force and effect. The specified legal rights of theparties may vary among different states and provinces. (read and initial)_______
By signing below, I confirm that I have read this Release of Liability, Waiver of Claims, Assumption of Risks, and Indemnity
Agreement for BCA Compressed Air Cylinder Refills and I am aware that I am waiving certain
legal rights which I or my heirs, next of kin, executors, administrators, assigns and representatives may have against theReleases.

________________________ ___________________________ ________________________
Signature

AddressWitness Signature________________________________________________

Printed Name

Printed Name

For Minors: I verify that I am the parent or legal guardian of the minor(s) listed below and have the authority to enter into
this agreement on behalf of the minor(s), and on his/her/their behalf, I agree to be bound by the terms of this Release ofLiability, Waiver of Claims, Assumption of Risks, and Indemnity Agreement for BCA Compressed Air Cylinder Refills.

________________________ ___________________________ ________________________
Printed Name of Minor

Address

Witness Signature________________________________________________

Date of Birth

Printed Name________________________
Parent/Guardian Signature________________________
Printed Name