Name *

First Name

Last Name

Phone

(###)

###

####

Birthday (18+ please) *

MM

DD

YYYY

Your Outdoor Interests *

Backpacking

Bird Watching

Hiking

Hunting

Just Love Being Outside!

Kayaking

Skiing/Snowboarding

Cycling

Fishing

Golfing

Rock/Ice Climbing

Running

Surfing

Yoga

Other (please list below)

Checkbox *

*Outdoor Mindset Legal Waiver* Outdoor Mindset (OM) is a non-profit organization that builds community for adults affected by neurological challenges through connection with each other and the outdoors. Community members are volunteers only and donate their time and energy to OM and to those with whom they develop relationships. OM staff and OM members are not, and are not part of the OM network to act as, licensed medical or mental health/healthcare professionals or therapists. OM’s policy and express instruction to each member is that no member may recommend or endorse any medical or non-medical tests, treatments, medicines, drugs physicians, products, procedures, opinions, or other information to another member or otherwise give ‘medical’ advice to another member. Further, no member should ever construe anything relayed to him or her by any other member as medical advice, treatment recommendation, or opinion. The sole purpose of the relationships set up through OM is the offering and receipt of inspiration and support. Under no circumstance should any member solicit or offer professional, financial, medical, or other similar advice or assistance from or to, respectively, another member. By your participation and/or involvement with OM, you expressly indicate your understanding that the relationships established among any of the members are founded, and should be based, solely on inspiration and support (as indicated herein) and are not intended to be substitutes for professional treatment, advice, or diagnosis of any kind or nature. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding any medical condition, whether it be yours or another person’s condition. Please do not disregard professional medical advice you have received from your doctors or delay in seeking professional medical advice because of communication with anyone associated with OM or because of something you have read on our website or received from any member. The content of OM’s website (www.outdoormindset.org) and any communication or publication of, from, or by OM is only to be read and/or used for informational purposes and is not intended to be a substitute for professional treatment, advice, or diagnosis. I, and my heirs, in consideration of my participation in the membership with Outdoor Mindset, hereby release Outdoor Mindset, Outdoor Mindset volunteers, sponsors, partners, and any other person officially connected with Outdoor Mindset, from any and all liability for damage to or loss of personal property, sickness or injury from whatever source, legal entanglements, fines, imprisonment, death, or loss of money, which might occur while participating in Outdoor Mindset membership, programs and events. I am aware of the risks of participation. I understand that this is a legal document and that I am giving up my right to sue or otherwise make any claim against Outdoor Mindset, Outdoor Mindset volunteers, sponsors, partners, and any other person officially connected with Outdoor Mindset, and that I am responsible for any medical or other costs that I may incur as a result of my participation. In order to keep our records as accurate as possible, please update us of any major changes by emailing connect@outdoormindset.org. Thank you and keep livin’ big! Do you agree to these terms?

Yes, I Agree