Emergency Contact Information

Please enter the name of the parent or guardian who should be contacted in the case of an emergency.

If you wish for us to be able to administer any medication, from sunscreen to emergency use of Tylenol or most important, Benadryl, this must be signed. It is a good idea in case of an extreme possibly life or death reaction to have permission to give a child’s dose of Benadryl if they go into an anaphylactic reaction to something. We’ll only administer what is expressly authorized by parents on the form. All medications must be provided by the parent or guardian and be in the original container.

Informed Consent

In consideration of the acceptance of my application for the above program, I hereby waive, release, and discharge any and all claims for damages for personal injury or property damages which may hereafter occur to me as a result of participation in said event. This release is intended to discharge in advance Nurtured by Nature Outdoor Elementary School, its employees, volunteers and agents from liability, even though that liability may arise out of perceived negligence on the part of participant(s).  It is understood that some outdoor activities involve an element of risk or danger of accidents, and knowing those risks, I hereby assume those risks.  It is further understood and agreed that this waiver, release, and assumption of risk is to be binding on my heirs and assignees.

Participant agrees to participate in activities including, but not limited to: physical education, cooking, art and craft, and/or other activities that may include exposure to equipment, chemicals, natural hazards and environmental hazards not typically found in an indoor learning environment.  As a condition of participation in learning activities while under the care and supervision of Nurtured By Nature, wherever situated, Participant's Parent/Guardian on behalf of participant agree as follows:

School activities involve risks and dangers that may cause damage to clothing, injury, disability, or even death. I am fully aware of any and all risks and dangers connected with the Activity, including, but not limited to, bruising, burns, cuts, scrapes, sprains, strains, irritation, bleeding, pain, soreness, contusions, soft tissue injuries, fractures, head injury, spinal injury, weakness, disability, death, or other injuries or illness.  Further, I am aware that there may be risks and dangers unknown to me that may exist or arise before, during or after participation in camp;
I and Participant shall jointly share in the responsibility for Participant's safety and ensure that Participant refrains from endangering others who are participating in activities while under the care and supervision of Nurtured by Nature;
Participant and Parent/Guardian of Participant on Participant's behalf acknowledge that there are inherent dangers in learning activities in outdoor learning environments;
Should Parent/Guardian of Participant become aware of an accident or injury sustained by Participant while under the care and supervision of Nurtured By Nature, wherever situated, Parent/Guardian agrees to promptly report the incident to Nurtured By Nature's Owner/Director Vanessa Scriven 206-778-5819;

Participant must refrain from use of alcohol or illegal drugs while under the care and supervision of Nurtured By Nature;
Learning activities with Nurtured By Nature, wherever situated, are voluntary; Participation is voluntary and no inducements, representations, or guarantees have been made regarding or relating to school activities;
Participant will only engage in activities for which participant has adequate physical capacity;
Participant’s Parent/Guardian expressly warrants and represents that Participant currently is, and at all times during which Participant participates in activities with Nurtured By Nature, covered by health and accident insurance providing benefits of no less than $5000.00 per incident to cover risks of injury or illness associated with the activities in which Participant participates;
In case of emergency, accident, or illness, Participant's Parent/Guardian, on behalf of participant, hereby grants permission for participant to be treated by a professional medical person and admitted to a hospital if necessary, and Parent/Guardian further agrees to be the party responsible for all medical expenses, which are thereby incurred on Participants behalf.

 Please read this carefully before signing.  Your signature indicates that you understand it and agree to its terms.  By signing this Release, you and Participant are giving up certain legal rights, including the right to sue or recover damages in case of property damage, injury, death, or disability, including but not limited to, the negligence or fault of EdenAcres and any and all persons or entities in any way affiliated or associated, directly or indirectly, with Pacific (collectively, “Released Parties”).  

INDEMNIFICATION AND RELEASE

 In consideration for allowing Participant to participate, I, the authorized Parent/Guardian of Participant, on behalf of myself, Participant, and my and Participant’s heirs and assigns, expressly acknowledge and agree:

To release, waive, and indemnify, defend, and hold harmless EdenAcres, its board members, officers, employees, students, and volunteers from all claims, suits, or actions of any nature arising out of Participants participation in activities while under the care and supervision of EdenAcres, wherever located, other than intentional or grossly negligent acts of EdenAcres, its board members, officers, employees, students, and volunteers.  
To indemnify, defend, and hold harmless the Released Parties for any Claims, other than Claims resulting directly from the intentional or grossly negligent acts of the Released Parties.
This Release extends to all acts of negligence of the Released Parties and is intended to be as broad and inclusive as is permitted by law.  If any portion of this Release is found to be unenforceable, the balance of the Release shall continue in full legal force and effect.  This Release shall be governed by the law of the State of Oregon and any claim relating to Released Parties must be brought in Douglas County, Oregon. 

By signing below, I warrant and represent that I am the parent or legal guardian of Participant, I have full right and authority to sign on behalf of myself, Participant, and all heirs and assigns, and that I assume full responsibility for any and all risks (known and unknown) for Participant’s voluntary participation in activities while under the care and supervision of Nurtured By Nature, including but not limited to the general risks enumerated below:

General Risks

While participating in outdoor activities, Participants are encouraged to wear protective clothing to prevent exposure to poison oak and other skin irritants and sun block lotions to prevent sunburn;
While participating outdoor activities and farming activities Participants should wear closed-toe shoes with non-slip soles to account for insects as well as rugged and moist terrain;
Persons who are sensitive or allergic to bee stings should bring appropriate protection and medication and notify Nurtured By Nature staff of this fact in advance of participation;
Participants working with tools and equipment should wear gloves and other protective gear to avoid injury;
Nurtured By Nature sites may contain ponds, creeks, or other water features. Care must be taken in areas near water.

By his/her signature below, Parent/Guardian warrants and represents that he/she has read this informed consent agreement and understands same and, further, that he/she agrees to be bound by the covenants, representations, warranties, conditions, indemnification provisions, assumptions of risk and consent contained in this consent agreement, and that the enforceability of provisions affecting liability, indemnification, insurance coverage and assumption of risk shall survive the termination of this agreement.

 I HAVE READ THIS RELEASE, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I AM GIVING UP CERTAIN LEGAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCMENT, ASSURANCE OR GUARANTEE BEING MADE TO ME.  I INTEND MY SIGNATURE TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.

 

Photo Release

For publicity and recognition that may be received, I hereby grant permission to Nurtured By Nature for Participant and myself to be photographed without further compensation, understanding that this product is intended for any Nurtured By Nature publication of promotional purpose in print media, television video, motion picture, or Nurtured By Nature website.  In addition, I consent to the use of participant’s and my name and/or interview comments in connection with any Nurtured By Nature publication or promotional purposes in print media, television, video, motion picture, or Nurtured By Nature website.  Any other use or said images, Participant’s name, my name and/or interview comments require my permission in advance.

INFORMED CONSENT

PHOTO RELEASE