Activity Group Waiver and Assumption of Risk

          I acknowledge that this activity of the Probus Club of Vancouver West in which I am participating involves risks which are                beyond the control of the Club. Notwithstanding the acknowledgement of such risks, I hereby release the Probus Club of                Vancouver West, its officers, directors, volunteers and members from all claims for damage or injury arising as a result of              my participation in this activity organized by the Club.

          I agree to pay the cost of any emergency evacuation of my person or belongings that may be necessary. I affirm that I am              aware of the nature of the activity, its length, duration and degree of difficulty and that I am properly equipped and                         physically able to participate. I have no medical or other condition which might preclude my participation. I agree to follow             the instructions of the leader.

          I acknowledge that, in addition to myself, this waiver of liability waiver applies to my personal representatives, successors,              heirs and assigns. I have read this Waiver and Assumption of Risk and I fully understand all aspects of it.

          Description of Activity:      _____________________________________________________

          OR Individual Event: (date) _____________________________________________________

          Name: (please print)          _____________________________________________________

          Signature:                           _____________________________________________________

          Emergency Contact:         _____________________________________________________

          Contact Telephone:         ______________________________________________________