1- This registration contains sections that will require electronic signatures that can only be placed by the participant of the TOP. If you are filling out this form on behalf of someone else who is older than 18 years of age (adult), it is strictly necessary that the participant is with you while filling out the form so he is able to place the "e-signatures". If you are filling out this form on behalf of a minor, you must be the parent or the legal guardian of the minor for whom this form is being filled out.
The participant (+18 age) is present to digitally sign this form.*
I agree to be reimbursed with the 50% of payment if participant is not able to go.*
E-mail of the person who is filling out this form*
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PLEASE READ CAREFULLY
About Colorado weather
The state of Colorado is unique in its geographical and climatic configuration, and although we carefully plan all logistics and execution details of the TOP, it is not possible to anticipate any climatic condition that for security reasons we are forced to postpone the TOP for a later date from the one that has been announced and published. If this is the case, Legendary Front Range its officers or directors, cannot be and will not be responsible for compensating or reimburse any travel, accommodation expenses or loss of job for participants who travel to Florida to participate in the TOP on the date originally planned and publicized. If you want to proceed with the registration, by clicking check the box below you accept to assume this risk. If not, you can close this form now.
Payments
When you fill out all the fields of the registration, you will access the payment platform (Square) where you can make your investment to participate ($185.00). This payment reserve a spot in the TOP. You will be completely registered once the payment has been processed.
I accept*
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Participant name*
DOB*
TOP Date:*
August 1-4 2024 June 19-22 2025
Email:*
Address*
Phone:*
Marital status*
Single Married Divorced United Widowed Separated
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Complete participant information:
LEGENDARY #*
IMPORTANT NOTE
a) If you have not obtained the TOP certification of Track Outdoor de Potencial, it requires that you be certified to assign you a service position. We will send you the next dates to get certified if you indicate that you are not certified. Or on the day of the event you can present yourself with your certification if you received it at any other official location by legendarios.
¿Are you certified?*
Yes No
b) If you are a legendary Colorado local, you need to have your first aid training so that you can be trained to deal with specific situations. You can get it in the community where it is shared, you can also do it online if you prefer at the following link:
1. Costo de certificación de RCP en línea
2. First Aid Online
Send a photograph with your card or certificate information to 720-234-5723, if you already have certification or when you obtain it.*
I already have certification! I will get the certification!
The best hope is that we can be trained to serve each participant, team members, much better and with quality, and it is something that can be used even for our daily lives. We appreciate your understanding and support.
Department in which you served in the last TOP you participated*
This will be the first time that I serve Logistics, Events (Chief of Tribe), Rescue, Administration, Directive, Media (Production)
Emergency contact information:*
Contact Name:
Contact Email:
Country Contact:
Contact Phone:
ABOUT MEDICAL INSURANCE IN THE TOP FRONT RANGE
READ CAREFULLY
MEDICAL/MEDICAL INSURANCE: You can participate in the TOP Front Range even if you don't have medical/accident insurance, but it will be your responsibility to cover medical expenses in case of an accident. Take note that some Insurance companies can offer coverage for medical/accident expense for specific periods of time, thus you can purchase medical coverage for the dates of the event. Please consult a certified Insurance agent.
Next Section: Waiver
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Through this statement I certify the following:
1- That I am the TOP participant for whom this form is being completed OR THAT I am the parent or guardian or have legal custody of the participant if the participant is a minor.
2- I am not signing the following forms on behalf of someone else unless I am completing those forms on behalf of a minor of whom I am the parent or of whom I have legal custody.
3- I have the legal authority to sign such forms
These forms and all their sections comply with the Security Procedures and statutes specified in the State Statutes and any other State or Federal Law regarding digital signatures.
I Agree*
If you agree, continue or leave the page.
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LEGENDARY – TRACK OUTDOOR DE POTENCIAL
WAIVER, DISCLAIMER, INDEMNITY AND CONSENT FOR MEDICAL CARE
1. Voluntary participation.
I understand and confirm that my participation in LEGENDARIOS, presented and organized by Front Range, is based on my voluntary wish.
2. Risk Identification.
I understand that my participation in LEGENDARIOS may involve risks of injury and loss, both to the person and to the property. I also understand that the risk of injury may include, but is not limited to, the possibility of temporary or permanent disability or death. I understand that this waiver, release of liability, indemnification, and consent for medical care is intended to address all risks of any kind associated with my participation in any aspect of LEGENDARIOS, or during the time that I will be involved in LEGENDARIOS, including risks created by the actions, omissions, carelessness or negligence on the part of LEGENDARIOS Front Range or its executives, pastors, employees, agents, volunteers, successors or assignees of Front Range, including, but not limited to, risks created by the following situations: a. The use and status of the different modes of transport, premises, facilities, equipment, and to and from and during the LEGENDARY event; b. The insufficiency or lack of policies, rules, or regulations for the LEGENDARIES; c. The failure of LFRC or its representatives to foresee or protect me from the actions, omissions or negligence of any person, animal or another natural phenomenon, or the reckless, willful, or criminal misconduct of persons who are not affiliated with LFRC; The insufficiency or unavailability of medical facilities or treatment; or d. The insufficiency or lack of LFRC or its representatives.
3. Assumption of Risk.
I understand that LEGENDARIOS will be an extreme physical challenge event, in a natural outdoor setting, without the protections provided by the elements. I assume all risks, known and unknown, foreseeable and unforeseeable, related in any way to my participation in LEGENDARIOS. I accept personal responsibility for any situation, injury, loss, or damage related in any way to my participation in LEGENDARIOS. The following is a list of risks, however, this list is not intended to be exhaustive:
a. Acts of God or the elements of nature such as weather changes, extreme temperatures, rain, thunder and lightning, hypothermia and heat exhaustion;
b. Injuries associated with hiking, mountaineering, hiking, kayaking, canoeing, and physical activity, such as impacts with rocks and trees, physical exhaustion, and drowning;
c. Exposure to wild plants, wild animals, and the bites or stings of animals including insects, snakes, bears, bobcats, and wild boars (etc).
4. Release of liability.
Libero LEGENDARIOS, FR. and its representatives from any liability and I waive any claim for civil liability, injury, unavailability or rebellion to continue with the activity (TOP) for any reason, loss, damage or expense, including attorneys' fees, related in any way to my participation in LEGENDARIOS, whether or not caused in whole or in part by the negligence or other fault of LEGENDARIOS, or LEGENDARIOS FRONT RANGE or their representatives (a "claim").
5. Compensation.
I agree to indemnify and hold LEGENDARIOS FRONT RANGE and its representatives without damage or harm related to a claim, or any expense, including attorney's fees (cost of defense against any claim that I could personally make, or that can be made in my name) and that has already been released from liability through this document, related in some way to a claim.
6. Binding effect.
This instrument will be binding on my relatives, personal representatives, heirs, beneficiaries, relatives, and assignees, and will benefit LEGENDARIOS FRONT RANGE and its representatives.
7. Divisibility.
If any provision (or part of any provision) of this instrument is held invalid or unenforceable, such provision will be enforceable in part, to the extent permitted by law, and such invalidity or unenforceability will not otherwise affect any other disposition of this instrument.
8. Applicable law.
Because LEGENDARIOS, will be carried out in the State of Colorado, and in order to offer security according to the law and applied in the construction of this instrument, it will be governed, interpreted, and executed in accordance with the law of the State. from Colorado.
9.Marketing Authorization.
LEGENDARIOS FRONT RANGE and its representatives may record each LEGENDARIOS participant, at different times of the LEGENDARIOS event through videotapes, audiotapes, or photography, and may use the participant's name, voice, or testimony without restrictions for the future. for promotional purposes of LEGENDARIOS / LEGENDARIOS FRONT RANGE unless otherwise stated in writing.
10. Consent for medical treatment.
I authorize LEGENDARIOS FRONT RANGE and its representatives, if present, to provide me, through medical personnel of their choice, with usual medical assistance, transportation, and emergency medical services if required or transportation or services as a result of an injury or damage related to my participation in the LEGENDARIES. This consent is given prior to any specific diagnosis, treatment, surgery, or medication, and is given to provide specific authorization and consent for medical/dental treatment and care on my behalf. This consent does not impose an obligation on LEGENDARIOS / FRONT RANGE and its representatives to provide such assistance, transportation, or service.
11. Abstinence:
I am not bringing any kind of drugs, alcohol, or cigarettes. If I consume any of these things during the activity, I agree to be sent immediately to my place of residence and my emergency contacts will be notified. The return to my place of residence, if I do not comply with this provision, will be an expense fully paid by myself or by my parents or legal guardians.
12. Health insurance:
I certify that I have personal health insurance for the provision of medical services for myself and that it will provide coverage for the duration of LEGENDARIOS. This coverage will fully insure me for the duration of the LEGENDARIOS event. If I do not have coverage, then I agree to insure or personally cover the related expenses. If I am traveling internationally, my health insurance includes full coverage in the foreign countries where I am going to travel, without territorial limitations. I understand that LEGENDARIOS FRONT RANGE and its representatives do not provide any health plans and that all medical expenses are my responsibility.
THIS IS A WAIVER, DISCLAIMER, INDEMNITY, AND CONSENT. I HAVE READ THIS DISCLAIMER, RELEASE OF LIABILITY, INDEMNITY, AND CONSENT. I UNDERSTAND THAT I HAVE WAIVED SUBSTANTIAL RIGHTS IN SIGNING IT. I AM SIGNING THIS WAIVER, RELEASE OF LIABILITY, INDEMNITY, AND CONSENT ON A VOLUNTARY BASIS.
Initials*
Signature*
By placing your initials and signature above, you are accepting each of the points of the Waiver Form. An email with a copy of this waiver will be sent upon registration.
Next Section: "Medical Condition Report"
MEDICAL CONDITION REPORT
Extreme Character Challenge - Medical Condition Report
VACCINES:
LEGENDARIOS FRONT RANGE recommends that the participant have up-to-date tetanus shot and all other shots are up-to-date.
Have you been vaccinated against covid19?*
—Please choose an option— Si No
Do you have or have you ever had any of the following?*
1.Food Allergies
—Please choose an option— Yes No
2. Allergy to Penicillin or another drug (enter name below)
—Please choose an option— Yes No
3. Allergy Sting or bite of insects
—Please choose an option— Yes No
4. Allergy to poison sumac, oak, or ivy
—Please choose an option— Yes No
5. Previous operations or serious surgeries
—Please choose an option— Yes No
6. Vital Current Medications (List Below)
—Please choose an option— Yes No
7. Diabetes
—Please choose an option— Yes No
8. Convulsions
—Please choose an option— Yes No
9. Fainting
—Please choose an option— Yes No
10. Heart problems
—Please choose an option— Yes No
11. Eating disorders or stomach problems
—Please choose an option— Yes No
12. Respiratory problems
—Please choose an option— Yes No
13. Psychiatric Care
—Please choose an option— Yes No
14. Take medicine for depression or behavior control
—Please choose an option— Yes No
Please explain if you have selected YES to any of the questions above
Leave blank if all answers above are "no"
Special diet: (Name)
Please note: Special diets will not be provided at the event by the institution hosting LEGENDARIOS unless medically necessary, and in which case the participant must bring their own food supply.
Please explain any other important medical information that a medical provider needs to be aware of during their time at LEGENDARIOS – TRACK OUTDOOR DE POTENCIAL
I ACKNOWLEDGE THAT THE ABOVE INFORMATION HAS NOT BEEN PROVIDED WITH THE INTENTION OF PLACING OR ASSIGNING LIABILITY TO BLO / CCPP FOR MAINTAINING THE WELFARE OF THE PARTICIPANT, HOWEVER, THIS INFORMATION IF IT IS BEING CAPTURED TO SHARE TO ANY EMERGENCY SUPPLIER, IN CASE OF EMERGENCY RECOGNITION IN CASE TOGETHER WITH THIS MEDICAL CONDITION REPORT, I HAVE SIGNED THE WAIVER OF LIABILITY, INDEMNITY AND CONSENT TO MEDICAL CARE, WHICH IS PART OF THIS DOCUMENT (insert your initial)
I accept the terms and conditions
Write your Initials*
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