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George Junior Republic
Adventure-Based
Team Building Program
George Junior Republic: A Place for Team Building
Is your corporation or group
interested in building a team
environment, but not
certain on how to develop this
culture?
Are you a community leader with
interest in developing the
untapped potential of your group
members?
Located on 500 acres of Mercer County, Pennsylvania, George Junior Republic
is home to one of the largest indoor ropes courses on the East Coast. The
Adventure-Based Team Building Facility is a place where professionals can
build individual and team skills to take back to the work place. Community
groups can use the Adventure-Based Team Building Facility as a place to
develop problem solving and critical thinking skills.
The Adventure-Based Team Building Program challenges your group to move
from the ground to the sky in a safe, fun environment. Certified counselor-
trainers are on hand every step of the way. Participants will work together to
excel at accomplishing tasks while building trust, confidence and success.
Community and work environments are changing rapidly and the staff at
George Junior Republic is ready to help
your team adapt to the changes.
2
The facility was built thanks to the generosity of the Richard King Mellon Foundation.
Table of Contents 3
Beyond A One Day Experience 4
Overview of Services 5
Ropes Course Facility 6
Ropes Course Facility continued 7
Staff & Soar 8
Adventure-Based Team Building Fee Schedule 9
Group Leadership 10
Participant Item List 11
Group Goals Sheet 12
Attendee Check List 13
Participant Registration 14
Release of All Claims 15
Release of All Claims continued 16
Medical Release Information 17
Medical Release Form 18
Directions to GJR & Map of Campus to Adventure-Based Team
Building Facility
19
Contact Information 20
Challenge courses provide unparalleled learning and growth.
Through the power of shared unique experiences, the group
members push the boundaries of their self-imposed
limitations. This is the kind of learning that leads to practical
applications in the corporate setting in the areas of
communication, problem solving and enhancing leadership.
There are multiple layers of programming available to
meet the goals and objectives that you set for your
group.
Ground Initiatives: Group dynamics shift in a low
perceived risk environment.
Trust Building Initiatives: Completed on the ground or in
the air, these experiences increase the level of
emotional risk.
12’, 22’ or 32’ High Challenge Courses: High perceived
risk challenges create a unifying group experience.
Stand-Alone High Air Elements: Experience the support
and encouragement of the team in a novel situation.
Beyond A One Day Experience4
5
George Junior Republic invites you to enjoy the challenge of the on-campus ropes course that is
one of the largest indoor climbing facilities on the East Coast! The ropes course was designed to
provide adventure-based counseling to campus youth. The Adventure-Based Team Building
Program is now available to various groups and corporations for use in assisting team leaders in
developing institutional change.
George Junior Republic is founded on building individual success and takes this approach with
corporate ropes program participants. Staff members assist to:
 Improve communication
 Build leadership skills
 Develop and improve team dynamics
 Develop problem solving and critical thinking skills
These skills are developed by our trainers who support your group in working outside of their
comfort zone to build a team support network, which encourages trust, personal growth and the
power from a shared learning experience.
Once your team completes the Adventure-Based Team Building Program, there will be a new
sense of empowerment and your team will feel more comfortable giving and receiving feedback.
We look forward to working with your team here at George Junior Republic!
Ropes Course Facility6
The Adventure-Based Team Building Program at George Junior Republic offers a variety of high
ropes elements to enhance the team building process. A typical high ropes session entails an
introduction to the facility and safety instructions. Following this, participants will be given a
detailed description of the air elements and the fun begins!
The Pamper Pole
This 24-foot utility pole provides participants a way to
experience personal growth in a unique way. Once reaching the
top, they are asked to stand and jump to a trapeze bar that is
five feet away. During group processing, participants are asked
to reflect on the shared experience.
Swings
This 20-foot element consisting of four large swings provides the
opportunity for participants to hone their collaboration, planning and
listening skills. The pair must successfully transverse the element to reach their goal.
Dangle Duo
This free-hanging 30-foot ladder provides a chance for participants to
increase their problem solving skills, enhance trust among team
members and improve communication skills. As a pair, the climbers
progress up the six-rung ladder and will soon notice the rungs become
further apart.
Relay of Elements
Consists of four very different air elements:
 The Firecracker Ladder
 Centipede Ladder
 Rings
 Climbing Wall
These obstacles provide both physical and mental challenges and test
personal limits, along with the opportunity to identify one’s strengths and
weaknesses. The importance of goal setting can play a fundamental role in this challenge.
Climbing Wall
This 32-foot wall has seven different faces and various levels of difficulties to suit any needs.
However, willingness to try, open-mindedness and encouragement will vastly help all groups
achieve success. The climbing wall provides participants a chance to showcase their critical
thinking skills and step outside their comfort zones.
Ropes Course Facility 7
Staff members are Level-II Practitioners certified through the
Association of Challenge Course Technology (ACCT)*. Collectively, they
have over 25 years of experience involving ropes course management
and programming!
Staff & SOAR
During the session, your team will begin to internalize the full-value community, “SOAR
HERE.” We ask that participants be Safe, Open, Accountable, Respectful and Here. When
internalized, these values have the potential to turn your group into a high-functioning
community.
Be Safe: Understand the value of empathy and camaraderie by fostering a safe
environment where participants are able to better care for themselves and those around
them.
Be Open: Growth is experienced by being willing to step outside of your comfort zone to
participate in initiatives and process them through interactions with others.
Be Accountable: Individuals take responsibility for their actions, hold others
accountable, and process how their actions can impact the entire group
experience.
Be Respectful: New avenues of communication are discovered and participants refine
their skills for conflict resolution and constructive feedback.
Be Here: Engage in the adventure to discover the impact that can be made by being
invested and present minded.
*The Association for Challenge Course Technology (ACCT) is the world’s leading and largest American
National Standards Institute (ANSI) Accredited Standards Developer focused specifically and solely on the challenge course industry.
8
George Junior Republic’s Adventure-Based Team Building Program staff is excited about the
opportunity to serve your organization at our indoor ropes course. Our goal is to provide the skills
needed to become a high performing team.
The Adventure-Based Team Building Program staff can arrange a pizza and salad lunch at a cost
of $10 per person, if notified in advance of the event.
Your group is scheduled for ___________________________ (Date).
Your group will be on the George Junior Republic campus for ________ hours. The cost to your
group is $_______________ and does/doesn’t include lunch. Your group date will be reserved
upon receipt of the $100 deposit.
Group t-shirts are available upon request. The cost per t-shirt is $10.
Meeting space is also available upon request.
Adventure-Based Team Building Fee Schedule
Activity Length of Day Cost per Person Minimum
Deposit
Team Building/
Low Course
3.0 hours $50 $100
Team Building/
Low and High
Course
6.0 hours $100 $100
9
George Junior Republic requests your organization assign one person as group l
eader who will be responsible for all communication with George Junior Republic
staff, including outlining goals and objectives for the training and submitting the
payment to George Junior Republic before the event.
Prior to your event date, the Adventure-Based Program Director will need the
following information:
One Month Before Event:
 Schedule date and time with the Adventure-Based Program Director
 Report number of participants
 Send $100 deposit to the Development Office (check made payable to George
Junior Republic)
Three Weeks Before Event:
 Send Certificate of Insurance
 Send Group Goals sheet
One Week Before Event:
 Send completed Medical Release Forms
 Send completed Release of All Claims
 Send full payment (inclusive of program cost per person and lunch—if applicable)
 Arrange your own transportation to our campus. Directions and a map are
included
It is important you complete and send in all information prior to the event.
If cancellation occurs within three weeks of your scheduled event date, you will
forfeit your deposit; however, it may be used toward rescheduling another date.
Group Leadership10
Participant Item List
For comfort and safety concerns and to have a safe and fun
time, please do the following:
 Wear appropriate clothing
 T-shirt
 Shorts
 Jogging Pants
 Wear tennis shoes
 Do not wear jewelry
 Bring snacks and lunch
(if not provided)
 Bring a light jacket
11
Group Goals Sheet
Please make a photocopy of this completed form for yourself and return the original
to the Adventure-Based Program Director three weeks prior to your event. The group
leader is responsible for submission of this form.
Name:
Group:
Activity:
Date of Activity:
Time of Activity:
Please outline the group goals and any other information that would be helpful in
the design of the learning experience.
1. _____________________________________________________________________
2._____________________________________________________________________
3._____________________________________________________________________
4._____________________________________________________________________
5._____________________________________________________________________
Other pertinent information:
Goals
12
Group Name: Date of Activity:
Group Leader: Number of Groups:
Total # of Participants:
Please include the participant names and then check all the applicable
boxes to insure that all participants submitted the necessary information.
Attendee Check List 13
Participant Registration
# Name
Over
18
Under
18
Signature
Medical
Form
T Shirt
Size
Lunch
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
2
1
14
Release of All Claims
RELEASE OF ALL CLAIMS
I, the undersigned, hereby acknowledge that George Junior Republic, George Junior Republic in
Pennsylvania, and George Junior Republic Realty, all non-profit corporations organized in the
Commonwealth of Pennsylvania and located in Pine Township, Mercer County, Pennsylvania, all
hereinafter jointly referred to as “George Junior Republic,” have offered me an opportunity to
participate in the Adventure-Based Team Building Program located at the George Junior Republic
facilities in Pine Township, Mercer County, Pennsylvania. I understand that George Junior
Republic is under no obligation whatsoever to allow me to utilize the said facilities or equipment,
but I am interested and desirous of utilizing the same to participate in the Adventure-Based
Team Building Program.
I understand that I will be exposed to and participate in physical and mental stress challenges in
the Adventure-Based Team Building Program. I also understand that I will be at risk for injury by
my participation, but voluntarily agree to assume all such risk.
I hereby acknowledge having been given a copy of the Rules and Regulations concerning the
Adventure-Based Team Building Program and I agree to be bound by all the rules and
regulations, and further agree that I will not bring any guests to the said facility at any time. I also
acknowledge that I am familiar with the Program and that I am free to ask any further questions.
I also acknowledge that I can withdraw from the Program at any point in time.
As a condition of utilizing the said facilities and equipment and participating in the Adventure-
Based Team Building Program, I recognize and affirm that I am assuming a greater risk of injury
or loss. I understand that George Junior Republic makes no representations, warranties or
guarantees to me regarding the safety of the facilities and program, any particular equipment or
machinery I may utilize, and I voluntarily assume any and all risk, injury and liability to myself
which may occur therein. Furthermore, it is my responsibility to have myself medically examined
to ensure my fitness to utilize the said facilities as George Junior Republic has no responsibility
nor liability therefor.
As a condition of utilizing the said facilities and equipment and participating in the Adventure-
Based Team Building Program, I hereby RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO
SUE George Junior Republic, its officers, employees and agents for any and all claims, demands,
liabilities and causes of action whatsoever arising out of or related to any loss, injury, illness or
damage to myself which may occur from any act of omission or commission, negligent or other-
wise, committed by George Junior Republic, its employees, agents or students, during my
participation in any activity or use of the said facilities and equipment, as well as any
participation in any activity directed or supervised by George Junior Republic employees or
agents.
15
I also agree to assume all liability for and hereby agree to defend, INDEMNIFY AND HOLD
HARMLESS George Junior Republic, its officers, employees and agents, from and against any
losses or injuries to me arising out of, incidental to or in connection with all acts of omission or
commission, negligent or otherwise, committed during my use of the said facilities and
equipment and participation in the Adventure-Based Team Building Program, WHETHER SUCH
ACTS OF OMISSION OR COMMISSION, NEGLIGENT OR OTHERWISE, WERE CAUSED BY MYSELF
OR BY GEORGE JUNIOR REPUBLIC, ITS OFFICERS, EMPLOYEES, AND AGENTS, OR THIRD
PARTIES, AS WELL AS TO INDEMNIFY AND HOLD HARMLESS George Junior Republic, its officers,
employees and agents, from any and all reasonably incurred attorney’s fees in the defense of
any such action or the enforcement of the provisions of these Release Agreement.
I further state that I am of lawful age and legally competent to sign this affirmation and release
and understand that the terms herein are contractual and not a mere recital, and that I have
signed this document as my own free act. I acknowledge that no oral representations,
statements or inducements apart from this written agreement have been made to me.
Regardless of where the acts of omission or commission may occur, or where the injury to myself
may occur, I hereby agree that this Release shall be governed and controlled and interpreted
under the laws of the Commonwealth of Pennsylvania with venue and jurisdiction residing in the
Mercer County Court of Common Pleas.
I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM
AWARE THAT THIS IS A RELEASE OF LIABILITY AS TO MYSELF AND AN INDEMNIFICATION AND
HOLD HARMLESS AGREEMENT BETWEEN MYSELF AND GEORGE JUNIOR REPUBLIC, ITS
OFFICERS, EMPLOYEES AND AGENTS.
It is my express intent that this RELEASE AND HOLD HARMLESS AGREEMENT shall bind myself
and my personal representative, heirs and assigns.
IN WITNESS WHEREOF, AND INTENDING TO BE LEGALLY BOUND, I execute this Release this
________ day of _____, 2016.
____________________ ____________________
Witness Participant
This Release is due one week prior to your scheduled event.
Release of All Claims continued16
Medical Release Information
Dear Participant,
The Adventure-Based Team Building Program is designed to encourage positive risk
taking in a supportive, compassionate and noncompetitive environment. This
progressive program encourages participants to step outside of their comfort zones
in order to embrace new, transformative experiences. The Adventure-Based Team
Building Program utilizes a therapeutic process that begins with an experience,
which serves as a catalyst for change.
Professionally trained staff conduct the workshops that are physically and
psychologically demanding. Even with safety precautions, injuries are still
possible.
Surgeries, fractures, severe sprains or major illnesses that occurred less than one
year ago should be noted on the Medical Release Form and require a physician’s
release for participation. George Junior Republic reserves the right to refuse
participation to anyone who is observed by staff to demonstrate possible mental or
physical issues.
Signing the Medical Release Form and the Release of All Claims releases George
Junior Republic of liability for any personal injury that may occur during participation
in the Adventure-Based Team Building Program. You assume this responsibility and
understand the risks.
If you have any doubt about your physical or mental stability as it relates to
participation in the Adventure-Based Team Building Program, please talk with the
Adventure-Based Program Director and your physician before the medical deadline.
Medical Release Forms are due one week prior to your scheduled date of
activity.
Thank you for your cooperation.
The Ropes Course Staff at George Junior Republic
17
Name: Gender:
Weight:
Do you have any physical disabilities or conditions which might limit
participation? YES/NO
Do you have any allergies, surgeries, medications, etc. that the Adventure Based Team Building
Program staff needs to know about:
If yes, explain:
_________________________________________________________________________________
Have you ever been stung by a bee or wasp? YES/NO
Emergency Contact Information:
Name: ___________________________________________________________________________
Street:___________________________________________________________________________
City: ___________________________________State: __________________ Zip: ______________
Home Phone: _____________________________________________________________________
Cell Phone:_______________________________________________________________________
Work Phone: ______________________________________________________________________
_________________________________________________________________
Participant Name (print) Participant Signature
_________________________________________________________________
Name of Parent/Guardian if under 18 Signature of Guardian
*This information will be kept in confidence of the Adventure Based Team Building Program
staff.
Height:
GJR Medical Release Form18
20 Adventure-Based
Team Building Facility
Adventure-Based
Team Building Fa-
cility
Parking
From East and West
For those traveling on Interstate
80:
 Exit at the Grove City / Sandy
Lake exit, #24.
 Follow Route 173 South to-
ward Grove City for approxi-
mately .50 miles.
 Turn right onto George Junior
Road.
 Make a right on Farm Road.
 At the stop sign, turn right
onto Central Road.
From Pennsylvania Turnpike
For those traveling the PA turnpike:
 Exit at the Perry Highway/
Cranberry exit, #28.
 Follow signs for Interstate 79
North. Once on I79 North,
follow the directions for those
traveling NORTH AND SOUTH.
 The ropes course will be on
your left.
From North and South
For those traveling on Interstate
79:
 Exit at the Grove City exit,
#113.
 Follow Route 208 East for 1.5
miles.
 Turn left onto George Junior
Road (near Katie’s Korner).
 Proceed straight through the
light (Sheetz on right).
 Take the 4th left onto Farm
Road.
 At the stop sign, turn right
onto Central Road.
 The ropes course will be on
your left.
Please understand that George
Junior Republic in Pennsylvania is
1.5 hours from the Pittsburgh Inter-
national Airport and the Pittsburgh
Greyhound Station. If utilizing a
shuttle service, please add an
additional two hours to your travel
to allow appropriate time to arrive
at the airport or Greyhound station.
Directions to George Junior Republic
19
For more information & other questions, please contact:
Gillian Martin, Program Director
Adventure-Based Team Building Program
233 George Junior Road
Grove City, PA 16127
724-458-9330 x2066
ropes@gjr.org
Subject line: Corporate Ropes Course
Development Office
233 George Junior Road
Grove City, PA 16127
724-458-9330 x2171
“You just can’t stick to the “same old”
way of relating to each other in a
situation like this. If you want to get the
job done, you’re going to have to change
how you see yourself and your team.”
-Ropes Course Participant 2014
20

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Adventure Based Team Building Brochure

  • 2. George Junior Republic: A Place for Team Building Is your corporation or group interested in building a team environment, but not certain on how to develop this culture? Are you a community leader with interest in developing the untapped potential of your group members? Located on 500 acres of Mercer County, Pennsylvania, George Junior Republic is home to one of the largest indoor ropes courses on the East Coast. The Adventure-Based Team Building Facility is a place where professionals can build individual and team skills to take back to the work place. Community groups can use the Adventure-Based Team Building Facility as a place to develop problem solving and critical thinking skills. The Adventure-Based Team Building Program challenges your group to move from the ground to the sky in a safe, fun environment. Certified counselor- trainers are on hand every step of the way. Participants will work together to excel at accomplishing tasks while building trust, confidence and success. Community and work environments are changing rapidly and the staff at George Junior Republic is ready to help your team adapt to the changes. 2 The facility was built thanks to the generosity of the Richard King Mellon Foundation.
  • 3. Table of Contents 3 Beyond A One Day Experience 4 Overview of Services 5 Ropes Course Facility 6 Ropes Course Facility continued 7 Staff & Soar 8 Adventure-Based Team Building Fee Schedule 9 Group Leadership 10 Participant Item List 11 Group Goals Sheet 12 Attendee Check List 13 Participant Registration 14 Release of All Claims 15 Release of All Claims continued 16 Medical Release Information 17 Medical Release Form 18 Directions to GJR & Map of Campus to Adventure-Based Team Building Facility 19 Contact Information 20
  • 4. Challenge courses provide unparalleled learning and growth. Through the power of shared unique experiences, the group members push the boundaries of their self-imposed limitations. This is the kind of learning that leads to practical applications in the corporate setting in the areas of communication, problem solving and enhancing leadership. There are multiple layers of programming available to meet the goals and objectives that you set for your group. Ground Initiatives: Group dynamics shift in a low perceived risk environment. Trust Building Initiatives: Completed on the ground or in the air, these experiences increase the level of emotional risk. 12’, 22’ or 32’ High Challenge Courses: High perceived risk challenges create a unifying group experience. Stand-Alone High Air Elements: Experience the support and encouragement of the team in a novel situation. Beyond A One Day Experience4
  • 5. 5 George Junior Republic invites you to enjoy the challenge of the on-campus ropes course that is one of the largest indoor climbing facilities on the East Coast! The ropes course was designed to provide adventure-based counseling to campus youth. The Adventure-Based Team Building Program is now available to various groups and corporations for use in assisting team leaders in developing institutional change. George Junior Republic is founded on building individual success and takes this approach with corporate ropes program participants. Staff members assist to:  Improve communication  Build leadership skills  Develop and improve team dynamics  Develop problem solving and critical thinking skills These skills are developed by our trainers who support your group in working outside of their comfort zone to build a team support network, which encourages trust, personal growth and the power from a shared learning experience. Once your team completes the Adventure-Based Team Building Program, there will be a new sense of empowerment and your team will feel more comfortable giving and receiving feedback. We look forward to working with your team here at George Junior Republic!
  • 6. Ropes Course Facility6 The Adventure-Based Team Building Program at George Junior Republic offers a variety of high ropes elements to enhance the team building process. A typical high ropes session entails an introduction to the facility and safety instructions. Following this, participants will be given a detailed description of the air elements and the fun begins! The Pamper Pole This 24-foot utility pole provides participants a way to experience personal growth in a unique way. Once reaching the top, they are asked to stand and jump to a trapeze bar that is five feet away. During group processing, participants are asked to reflect on the shared experience. Swings This 20-foot element consisting of four large swings provides the opportunity for participants to hone their collaboration, planning and listening skills. The pair must successfully transverse the element to reach their goal. Dangle Duo This free-hanging 30-foot ladder provides a chance for participants to increase their problem solving skills, enhance trust among team members and improve communication skills. As a pair, the climbers progress up the six-rung ladder and will soon notice the rungs become further apart.
  • 7. Relay of Elements Consists of four very different air elements:  The Firecracker Ladder  Centipede Ladder  Rings  Climbing Wall These obstacles provide both physical and mental challenges and test personal limits, along with the opportunity to identify one’s strengths and weaknesses. The importance of goal setting can play a fundamental role in this challenge. Climbing Wall This 32-foot wall has seven different faces and various levels of difficulties to suit any needs. However, willingness to try, open-mindedness and encouragement will vastly help all groups achieve success. The climbing wall provides participants a chance to showcase their critical thinking skills and step outside their comfort zones. Ropes Course Facility 7
  • 8. Staff members are Level-II Practitioners certified through the Association of Challenge Course Technology (ACCT)*. Collectively, they have over 25 years of experience involving ropes course management and programming! Staff & SOAR During the session, your team will begin to internalize the full-value community, “SOAR HERE.” We ask that participants be Safe, Open, Accountable, Respectful and Here. When internalized, these values have the potential to turn your group into a high-functioning community. Be Safe: Understand the value of empathy and camaraderie by fostering a safe environment where participants are able to better care for themselves and those around them. Be Open: Growth is experienced by being willing to step outside of your comfort zone to participate in initiatives and process them through interactions with others. Be Accountable: Individuals take responsibility for their actions, hold others accountable, and process how their actions can impact the entire group experience. Be Respectful: New avenues of communication are discovered and participants refine their skills for conflict resolution and constructive feedback. Be Here: Engage in the adventure to discover the impact that can be made by being invested and present minded. *The Association for Challenge Course Technology (ACCT) is the world’s leading and largest American National Standards Institute (ANSI) Accredited Standards Developer focused specifically and solely on the challenge course industry. 8
  • 9. George Junior Republic’s Adventure-Based Team Building Program staff is excited about the opportunity to serve your organization at our indoor ropes course. Our goal is to provide the skills needed to become a high performing team. The Adventure-Based Team Building Program staff can arrange a pizza and salad lunch at a cost of $10 per person, if notified in advance of the event. Your group is scheduled for ___________________________ (Date). Your group will be on the George Junior Republic campus for ________ hours. The cost to your group is $_______________ and does/doesn’t include lunch. Your group date will be reserved upon receipt of the $100 deposit. Group t-shirts are available upon request. The cost per t-shirt is $10. Meeting space is also available upon request. Adventure-Based Team Building Fee Schedule Activity Length of Day Cost per Person Minimum Deposit Team Building/ Low Course 3.0 hours $50 $100 Team Building/ Low and High Course 6.0 hours $100 $100 9
  • 10. George Junior Republic requests your organization assign one person as group l eader who will be responsible for all communication with George Junior Republic staff, including outlining goals and objectives for the training and submitting the payment to George Junior Republic before the event. Prior to your event date, the Adventure-Based Program Director will need the following information: One Month Before Event:  Schedule date and time with the Adventure-Based Program Director  Report number of participants  Send $100 deposit to the Development Office (check made payable to George Junior Republic) Three Weeks Before Event:  Send Certificate of Insurance  Send Group Goals sheet One Week Before Event:  Send completed Medical Release Forms  Send completed Release of All Claims  Send full payment (inclusive of program cost per person and lunch—if applicable)  Arrange your own transportation to our campus. Directions and a map are included It is important you complete and send in all information prior to the event. If cancellation occurs within three weeks of your scheduled event date, you will forfeit your deposit; however, it may be used toward rescheduling another date. Group Leadership10
  • 11. Participant Item List For comfort and safety concerns and to have a safe and fun time, please do the following:  Wear appropriate clothing  T-shirt  Shorts  Jogging Pants  Wear tennis shoes  Do not wear jewelry  Bring snacks and lunch (if not provided)  Bring a light jacket 11
  • 12. Group Goals Sheet Please make a photocopy of this completed form for yourself and return the original to the Adventure-Based Program Director three weeks prior to your event. The group leader is responsible for submission of this form. Name: Group: Activity: Date of Activity: Time of Activity: Please outline the group goals and any other information that would be helpful in the design of the learning experience. 1. _____________________________________________________________________ 2._____________________________________________________________________ 3._____________________________________________________________________ 4._____________________________________________________________________ 5._____________________________________________________________________ Other pertinent information: Goals 12
  • 13. Group Name: Date of Activity: Group Leader: Number of Groups: Total # of Participants: Please include the participant names and then check all the applicable boxes to insure that all participants submitted the necessary information. Attendee Check List 13
  • 14. Participant Registration # Name Over 18 Under 18 Signature Medical Form T Shirt Size Lunch 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 2 1 14
  • 15. Release of All Claims RELEASE OF ALL CLAIMS I, the undersigned, hereby acknowledge that George Junior Republic, George Junior Republic in Pennsylvania, and George Junior Republic Realty, all non-profit corporations organized in the Commonwealth of Pennsylvania and located in Pine Township, Mercer County, Pennsylvania, all hereinafter jointly referred to as “George Junior Republic,” have offered me an opportunity to participate in the Adventure-Based Team Building Program located at the George Junior Republic facilities in Pine Township, Mercer County, Pennsylvania. I understand that George Junior Republic is under no obligation whatsoever to allow me to utilize the said facilities or equipment, but I am interested and desirous of utilizing the same to participate in the Adventure-Based Team Building Program. I understand that I will be exposed to and participate in physical and mental stress challenges in the Adventure-Based Team Building Program. I also understand that I will be at risk for injury by my participation, but voluntarily agree to assume all such risk. I hereby acknowledge having been given a copy of the Rules and Regulations concerning the Adventure-Based Team Building Program and I agree to be bound by all the rules and regulations, and further agree that I will not bring any guests to the said facility at any time. I also acknowledge that I am familiar with the Program and that I am free to ask any further questions. I also acknowledge that I can withdraw from the Program at any point in time. As a condition of utilizing the said facilities and equipment and participating in the Adventure- Based Team Building Program, I recognize and affirm that I am assuming a greater risk of injury or loss. I understand that George Junior Republic makes no representations, warranties or guarantees to me regarding the safety of the facilities and program, any particular equipment or machinery I may utilize, and I voluntarily assume any and all risk, injury and liability to myself which may occur therein. Furthermore, it is my responsibility to have myself medically examined to ensure my fitness to utilize the said facilities as George Junior Republic has no responsibility nor liability therefor. As a condition of utilizing the said facilities and equipment and participating in the Adventure- Based Team Building Program, I hereby RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE George Junior Republic, its officers, employees and agents for any and all claims, demands, liabilities and causes of action whatsoever arising out of or related to any loss, injury, illness or damage to myself which may occur from any act of omission or commission, negligent or other- wise, committed by George Junior Republic, its employees, agents or students, during my participation in any activity or use of the said facilities and equipment, as well as any participation in any activity directed or supervised by George Junior Republic employees or agents. 15
  • 16. I also agree to assume all liability for and hereby agree to defend, INDEMNIFY AND HOLD HARMLESS George Junior Republic, its officers, employees and agents, from and against any losses or injuries to me arising out of, incidental to or in connection with all acts of omission or commission, negligent or otherwise, committed during my use of the said facilities and equipment and participation in the Adventure-Based Team Building Program, WHETHER SUCH ACTS OF OMISSION OR COMMISSION, NEGLIGENT OR OTHERWISE, WERE CAUSED BY MYSELF OR BY GEORGE JUNIOR REPUBLIC, ITS OFFICERS, EMPLOYEES, AND AGENTS, OR THIRD PARTIES, AS WELL AS TO INDEMNIFY AND HOLD HARMLESS George Junior Republic, its officers, employees and agents, from any and all reasonably incurred attorney’s fees in the defense of any such action or the enforcement of the provisions of these Release Agreement. I further state that I am of lawful age and legally competent to sign this affirmation and release and understand that the terms herein are contractual and not a mere recital, and that I have signed this document as my own free act. I acknowledge that no oral representations, statements or inducements apart from this written agreement have been made to me. Regardless of where the acts of omission or commission may occur, or where the injury to myself may occur, I hereby agree that this Release shall be governed and controlled and interpreted under the laws of the Commonwealth of Pennsylvania with venue and jurisdiction residing in the Mercer County Court of Common Pleas. I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AS TO MYSELF AND AN INDEMNIFICATION AND HOLD HARMLESS AGREEMENT BETWEEN MYSELF AND GEORGE JUNIOR REPUBLIC, ITS OFFICERS, EMPLOYEES AND AGENTS. It is my express intent that this RELEASE AND HOLD HARMLESS AGREEMENT shall bind myself and my personal representative, heirs and assigns. IN WITNESS WHEREOF, AND INTENDING TO BE LEGALLY BOUND, I execute this Release this ________ day of _____, 2016. ____________________ ____________________ Witness Participant This Release is due one week prior to your scheduled event. Release of All Claims continued16
  • 17. Medical Release Information Dear Participant, The Adventure-Based Team Building Program is designed to encourage positive risk taking in a supportive, compassionate and noncompetitive environment. This progressive program encourages participants to step outside of their comfort zones in order to embrace new, transformative experiences. The Adventure-Based Team Building Program utilizes a therapeutic process that begins with an experience, which serves as a catalyst for change. Professionally trained staff conduct the workshops that are physically and psychologically demanding. Even with safety precautions, injuries are still possible. Surgeries, fractures, severe sprains or major illnesses that occurred less than one year ago should be noted on the Medical Release Form and require a physician’s release for participation. George Junior Republic reserves the right to refuse participation to anyone who is observed by staff to demonstrate possible mental or physical issues. Signing the Medical Release Form and the Release of All Claims releases George Junior Republic of liability for any personal injury that may occur during participation in the Adventure-Based Team Building Program. You assume this responsibility and understand the risks. If you have any doubt about your physical or mental stability as it relates to participation in the Adventure-Based Team Building Program, please talk with the Adventure-Based Program Director and your physician before the medical deadline. Medical Release Forms are due one week prior to your scheduled date of activity. Thank you for your cooperation. The Ropes Course Staff at George Junior Republic 17
  • 18. Name: Gender: Weight: Do you have any physical disabilities or conditions which might limit participation? YES/NO Do you have any allergies, surgeries, medications, etc. that the Adventure Based Team Building Program staff needs to know about: If yes, explain: _________________________________________________________________________________ Have you ever been stung by a bee or wasp? YES/NO Emergency Contact Information: Name: ___________________________________________________________________________ Street:___________________________________________________________________________ City: ___________________________________State: __________________ Zip: ______________ Home Phone: _____________________________________________________________________ Cell Phone:_______________________________________________________________________ Work Phone: ______________________________________________________________________ _________________________________________________________________ Participant Name (print) Participant Signature _________________________________________________________________ Name of Parent/Guardian if under 18 Signature of Guardian *This information will be kept in confidence of the Adventure Based Team Building Program staff. Height: GJR Medical Release Form18
  • 19. 20 Adventure-Based Team Building Facility Adventure-Based Team Building Fa- cility Parking From East and West For those traveling on Interstate 80:  Exit at the Grove City / Sandy Lake exit, #24.  Follow Route 173 South to- ward Grove City for approxi- mately .50 miles.  Turn right onto George Junior Road.  Make a right on Farm Road.  At the stop sign, turn right onto Central Road. From Pennsylvania Turnpike For those traveling the PA turnpike:  Exit at the Perry Highway/ Cranberry exit, #28.  Follow signs for Interstate 79 North. Once on I79 North, follow the directions for those traveling NORTH AND SOUTH.  The ropes course will be on your left. From North and South For those traveling on Interstate 79:  Exit at the Grove City exit, #113.  Follow Route 208 East for 1.5 miles.  Turn left onto George Junior Road (near Katie’s Korner).  Proceed straight through the light (Sheetz on right).  Take the 4th left onto Farm Road.  At the stop sign, turn right onto Central Road.  The ropes course will be on your left. Please understand that George Junior Republic in Pennsylvania is 1.5 hours from the Pittsburgh Inter- national Airport and the Pittsburgh Greyhound Station. If utilizing a shuttle service, please add an additional two hours to your travel to allow appropriate time to arrive at the airport or Greyhound station. Directions to George Junior Republic 19
  • 20. For more information & other questions, please contact: Gillian Martin, Program Director Adventure-Based Team Building Program 233 George Junior Road Grove City, PA 16127 724-458-9330 x2066 ropes@gjr.org Subject line: Corporate Ropes Course Development Office 233 George Junior Road Grove City, PA 16127 724-458-9330 x2171 “You just can’t stick to the “same old” way of relating to each other in a situation like this. If you want to get the job done, you’re going to have to change how you see yourself and your team.” -Ropes Course Participant 2014 20