October 3-7th, 2024 Colorado River Rafting All Veteran Retreat

All Expenses Paid for qualified VET Center Verified Veterans. First Come, First Serve with 20 Veteran spots available per event! If the event that you signed up for is already full, you will be put on a waitlist for other future events and we will contact you once we have details on future events. This registration form works for each event but you can specify which one you are most interested in in the notes section.

All Itineraries can be seen at www.nkmedicalgroup.com/veteran-retreats

October 3-7th, 2024 Colorado River Rafting/Hiking All Veteran Retreat, Moab, Utah

Full but can waitlist

November 13-17th, 2024 Women's Veteran Retreat Jasper, Arkansas OPEN FOR REGISTRATIONS

We are so excited to see you at the events!!!

NK Medical Group

6750 Stapleton Drive South, Suite 101
Denver, CO 80216

Phone: (720) 261-4415

Email: noora@nkmedicalgroup.com

Participant Information

First Name *

Last Name *

Gender *

Birth Date * +

Do you have a Valid ID? Yes or no. *

Which event dates and location are you most interested in? Please see current available events above. *

Contact Information

Address 1 *

Address 2

City *

State *

Zip *

Phone *

Alternate Phone

Email Address *

Do you need assistance or access to a wheelchair during travel? *

Any travel restrictions (i.e. no air travel)? *

Are you a current VA or VET Center Employee? *

Are you a current VET Center Client? *

Which VET Center are you apart of? *

VET Center Counselor's Name *

VET Center Counselor's Phone *

Emergency Contact *

Relationship *

Emergency Contact Phone *

Do you have any special needs that we need to consider for activities like hiking, zip lining, horseback riding, water activities etc.? *

Are you afraid of heights? *

Any specific concerns with outdoor activities that you would like to address?

Health Questionnaire

NK Medical Group Veteran Outdoor Experience Events can be multi‐day wilderness expeditions in remote settings, where evacuation to modern hospital facilities is not immediately possible. You shoulld expect extreme weather conditions ranging from snow storms to sleet to extreme heat and humidity. Sudden environmental changes are to be expected and anticipated. Depending on what voluntary activity you pursue in your NK Medical Group trip, you may be required to hike up uneven, steep terrain, paddle for extended periods, experience long, tough days. Be sure that you are able to be responsible for yourself. If you have any questions about the activities and your participation, you can contact NK Medical Group.

You must answer each health question below but please keep in mind that a "YES" answer does not necessarily mean that you will not be able to attend the outdoor experience event.

Respiratory Problems/Asthma? *

Neurological issue? Seizures? Epilepsy? *

Diabetes or hypoglycemia? *

Dizziness or fainting episodes? *

Cardiac problems? *

Physical or sensory limitation? *

Do you have a history of frostbite or acute mountain sickness? *

Heatstroke/heat exhaustion? *

Are you currently taking any medications with restrictions? *

Any current hernia, fracture, dislocation, sprain, injury? *

Any allergies to insect bites or bee stings? If yes, please list them and severity of allergy. *

Are you currently pregnant? *

Is your Tetanus immunization up to date (in the last 5 years)? *

Alcohol use? If yes, how much? *

Any recreational drug use? *

Do you exercise regularly? *

Are you able to swim? *

Do you have any dietary restrictions? *

Do you have any food allergies? *

I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the below Terms of Acceptance *

I certify that this form is a complete and accurate statement of my health and that I have listed any conditions that may prevent me from fully participating. I understand that I am solely responsible for providing my own health insurance and for all medical expenses related to my participation in NK Medical Group's programs. In the event of a medical emergency, I grant my permission for any medical care which might become necessary. I understand that this is a no alcohol event and I agree to not consume alcohol during the event. ENFORCEABILITY. The invalidity or unenforceability of any provision of this Agreement, whether standing alone or as applied to a particular occurrence or circumstance, shall not affect the validity or enforceability of any other provision of this Agreement or of any other applications of such provision, as the case may be, and such invalid or unenforceable provision shall be deemed not to be a part of this Agreement.

AGREEMENT TO FOLLOW DIRECTIONS. I agree to observe and obey all posted rules and warnings regarding COVID-19, and further agree to follow any oral instructions or directions given by NK Medical Group, or the employees, representatives or agents of NK Medical Group. ASSUMPTION OF THE RISKS AND RELEASE. I recognize that there are certain inherent risks associated with the above described activity regarding COVID-19, acknowledge the contagious nature of COVID-19 and understand that CDC and public health authorities recommend the practice of social distancing, and I assume full responsibility for personal injury to myself and (if applicable) my family members, and further release and discharge NK Medical Group for injury, loss or damage arising out of my or my family's use of or presence upon the facilities of NK Medical Group, whether caused by the fault of myself, my family, NK Medical Group or other third parties.I acknowledge that NK Medical Group has followed all local and state requirements regarding the coronavirus pandemic to reduce the spread ofCOVID-19. I acknowledge that NK Medical Group cannot guarantee that I will not become infected with COVID-19. INDEMNIFICATION. I agree to indemnify and defend NK Medical Group against all claims, causes of action, damages, judgments, costs or expenses, including attorney fees and other litigation costs, which may in any way arise from my or my family's use of or presence upon the facilities of NK Medical Group. APPLICABLE LAW. Any legal or equitable claim that may arise from participation in the above shall be resolved under Colorado law. NO DURESS. I agree and acknowledge that I am under no pressure or duress to sign this Agreement and that I have been given a reasonable opportunity to review it before signing. I further agree and acknowledge that I am free to have my own legal counsel review this Agreement if I so desire. I further agree and acknowledge that NK Medical Group has offered to refund any fees I have paid to use its facilities if I choose not to sign this Agreement. ARM'S LENGTH AGREEMENT. This Agreement and each of its terms are the product of an arm's length negotiation between the Parties. In the event any ambiguity is found to exist in the interpretation of this Agreement, or any of its provisions, the Parties, and each of them, explicitly reject the application of any legal or equitable rule of interpretation which would lead to a construction either "for" or "against" a particular party based upon their status as the drafter of a specific term, language, or provision giving rise to such ambiguity. ENFORCEABILITY. The invalidity or unenforceability of any provision of this Agreement, whether standing alone or as applied to a particular occurrence or circumstance, shall not affect the validity or enforceability of any other provision of this Agreement or of any other applications of such provision, as the case may be, and such invalid or unenforceable provision shall be deemed not to be a part of this Agreement. DISPUTE RESOLUTION. The parties will attempt to resolve any dispute arising out of or relating to this Agreement through friendly negotiations amongst the parties. If the matter is not resolved by negotiation, the parties will resolve the dispute using the below Alternative Dispute Resolution (ADR) procedure. TRAVEL DURING COVID-19 I agree to not travel if I am sick, tested positive for COVID-19 and haven’t ended isolation, had close contact with a person with COVID-19 and haven’t ended quarantine, or are waiting for results of a COVID-19 test. We recommend that you get a viral test as close to the time of departure as possible (no more than 3 days) before you travel. Isolate if you test positive or develop COVID-19 symptoms. Wearing a mask over your nose and mouth is required in indoor areas of public transportation (including airplanes) and indoors in U.S. transportation hubs (including airports). Any controversies or disputes arising out of or relating to this Agreement will be submitted to mediation in accordance with any statutory rules of mediation. If mediation does not successfully resolve the dispute, then the parties may proceed to seek an alternative form of resolution in accordance with any other rights and remedies afforded to them by law.

I HAVE READ THIS DOCUMENT AND UNDERSTAND IT. I FURTHER UNDERSTAND THAT BY SIGNING THIS RELEASE, I VOLUNTARILY SURRENDER CERTAIN LEGAL RIGHTS.

In consideration of the services of NK Medical Group their agents, officers, volunteers, participants, employees, and all other persons or entities acting in any capacity on their behalf (hereinafter collectively referred to as "NK Medical Group"), I hereby agree to release and discharge NK Medical Group, on behalf of myself, my children, parents, heirs, assigns, personal representatives and estate, from any and all liability for injuries or damages I may incur or cause in connection with or arising out of my participation in NK Medical Group programming. Although NK Medical Group has taken reasonable steps to provide me with appropriate equipment and skilled staff, I acknowledge that participation in NK Medical Group activities presents known and unanticipated risks inherent in outdoor team building activities including, but not limited to, environmental risks and physical activity that may result in property damage, physical injury or death. I acknowledge these risks may include, but are not limited to, hazards of traveling by foot or vehicle to and from the event; physical exertion and stress associated with the activities; falling tree limbs or other objects, collision with the ground, boards, other people, trees, and other objects in the vicinity of the event; tripping, being dropped; injuries inflicted by animals, insects, or plants; adverse weather conditions that may change without notice including, but not limited to, lightning, rain, hail, high wind, and other weather conditions. Possible injuries and illnesses may include, but are not limited to, bruises, abrasions, loss of consciousness, hypothermia, frostbite, sunburn, heatstroke or exhaustion, dehydration, allergy symptoms, loss of wind, splinters and rope burns, cramps or injury to muscles, ligaments, tendons, and joints such as shoulder, rotator cuff, arms, lower back, knees, legs, ankles, broken bones, heart disorders, stroke or paralysis. I voluntarily consent to participate in NK Medical Group programming. I acknowledge and understand that it is my sole responsibility to decline, decrease or cease participation in the event of illness, injury or other medical condition. I understand that the staff may reduce or stop my participation in the best interest of my safety and wellbeing. I understand that it is solely my responsibility to maintain insurance, and to seek and receive medical evaluation and treatment for any symptoms that may arise out of or are related to my participation. I further agree to abide by all laws and NK Medical Group policies and procedures. I understand that photographs and video recordings are often made of NK Medical Group events. By signing below, I voluntarily grant to NK Medical Group, and its advertisers and agents, the right to record and use my name, image, and statements in any medium for educational or promotional purposes, consistent with the mission of NK Medical Group. I agree that all rights to the sound, still or moving images belong to NK Medical Group, and I voluntarily hereby waive the right to inspect or approve such images. I understand that these images may be used on the website belonging to NK Medical Group and its partners, and in print and broadcast media. In consideration of all of the notices contained herein, it is my express desire to participate in NK Medical Group’s programming at my own risk. In consideration of my participation in the activities and use of its facilities and equipment, I hereby voluntarily release, hold harmless, and forever discharge NK Medical Group and its officers, agents, employees, volunteers, and successors, on behalf of myself and my successors and assigns, from any and all liability for injuries or damages I may incur or cause in connection with or arising out of my participation in NK Medical Group programming. By signing below, I acknowledge that I have read and understand this document in its entirety and hereby voluntarily consent to all of its provisions. I understand that I may be giving up legal rights and/or remedies to which I may otherwise be entitled. I understand and agree that this agreement will be construed and governed by Colorado law and any dispute hereunder shall be resolved in a court of competent jurisdiction in Colorado. I certify that I am at least 18 years of age and I acknowledge agreement and acceptance to all terms of this agreement.

Event Applicant Signature and Date *

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