Participant Waiver

Participant Waiver

A current Participant Waiver is required for each person attending any Earthroots class and/or event, or visiting Big Oak Canyon. Please submit an updated form if any of the following information changes.
Participant Name*

First NameLast Name
Birth Date*

MonthDayYear
Gender*
Pronouns
E-mail*
example@example.com
Mobile Number*
Alternative Phone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact*

NamePhone NumberRelationship
Out-of-state Contact

NamePhoneRelationship
Medical Conditions: Please tell us about any medical conditions or allergies that might affect your participation:*

Feel free to email us with any additional information if necessary at info@earthrootsﬁeldschool.org or contact us here: eartrootsfieldschool.org • (949)709-5777 • P.O. Box 504 Trabuco Canyon, CA 92678

** If you have an allergy that causes an anaphylactic reaction, we require that you bring an EpiPen or equivalent medication. Earthroots staff can only administer an EpiPen or other medication with written permission from your physician. For more information & to receive a copy of the AUTHORIZED HEALTHCARE PROVIDER MEDICATION FORM email info@earthrootsﬁeldschool.org **

Photo Release: By signing at the bottom of this form I hereby grant free permission for Earthroots Field School to use images of the participant for outreach purposes, including but not limited to electronic or print materials. No participant names will be used. If you do not want photos of the enrolled participant to be taken or used for promotional purposes, you must state this in writing to info@earthrootsﬁeldschool.org.

Medical Release: In the event that I require medical attention while participating in this program, I hereby grant permission to Earthroots Field School and its representatives to provide for the rendering of such care, including diagnostic procedures, surgical and medical treatment, by authorized medical staff or their designees, as may in their professional judgment be necessary. I hereby acknowledge that no guarantees have been made to me as to the effect of such examinations or treatment. I acknowledge that I am responsible for all reasonable expenses in connection with care and treatment rendered during this period.

COVID-19 Notice: Earthroots follows California Department of Public Health protocols for COVID-19 precautions. By signing below, I agree to follow Earthroots policies regarding COVID-19 precautions at all times. Protocols can be found on our website: earthrootsﬁeldschool.org

RELEASE OF LIABILITY, ASSUMPTION OF RISK, WAIVER OF CLAIMS & INDEMNIFICATION AGREEMENT
Notice – By signing this document, you may be waiving certain legal rights, including the right to sue.

Release and Waiver of Claims; Assumption of the Risk; Indemniﬁcation Agreement

In consideration for the undersigned being allowed to use the Earthroots' facilities and participate in Guided Hiking, Biking Tours, Team Building, Gardening, Tidepooling and/or other Earthroots activities (collectively the “Activities”) provided by Earthroots Field School (the “Host”), the Participant, and the Participant’s parent(s) or legal guardian(s) if the Participant is a minor, do hereby agree, to the fullest extent permitted by law, as follows:

1) TO WAIVE ALL CLAIMS that they have or may have against the Host arising out of the Participant’s participation in the Activities or the use of any equipment provided by the Host (“Equipment”), including while receiving instruction and/or training;

2) TO ASSUME ALL RISKS of participating in the Activities and using the Equipment, even those caused by the negligent acts or conduct of the Host, its owners, afﬁliates, operators, employees, agents, and/or ofﬁcers. The Participant and his/her parent(s) or legal guardian(s) understand and accept that there are inherent risks of participating in the Activities and using the Equipment, which may be both foreseen and unforeseen, including but not limited to illness, serious physical injury and death;

3) TO RELEASE the Host, its owners, afﬁliates, operators, employees, agents, and ofﬁcers from all liability for any loss, damage, injury, death, or expense that the Participant (or his/her next of kin) may suffer, arising out of his/her participation in the Activities and/or use of the Equipment, including while receiving instruction and/or training. The Participant and his/her parent(s) or legal guardian(s) speciﬁcally understand that they are releasing any and all claims that arise or may arise from any negligent acts or conduct of the Host, its owners, afﬁliates, operators, employees, agents, and/or ofﬁcers, to the fullest extent permitted by law. However, nothing in this Agreement shall be construed as a release for conduct that is found to constitute gross negligence criminal conduct; and

4) TO INDEMNIFY the Host, its owners, afﬁliates, operators, employees, agents, and/or ofﬁcers, from all personal liability for any loss, damage, injury, death, expense or property damage that the Participant (or his/her next of kin) may suffer, arising out of participation in the Activities and/or use of the Equipment, including while receiving instruction and/or training.

Personal Responsibility

The Participant and his/her parent(s) or legal guardian(s) represent, with the intent that Earthroots rely thereon, that Participant has no physical or mental condition that precludes him/her from participating in the Activities or using the Equipment, and that he/she is not participating against medical advice.

The Participant and his/her parent(s) or legal guardian(s) understand that Participant’s participation in the Activities and use of the Equipment is voluntary, and further understand that he/she has the opportunity to inspect the Host’s Equipment and facilities before any participation. The Participant and his/her parent(s) or legal guardian(s) shall indemnify and hold harmless Earthroots for any liability sustained by Earthroots or its agents as a result of the negligent, willful or intentional acts of the Participant.

The Participant and his/her parent(s) or legal guardian(s) understand that Participant is obligated to follow the rules of the Activities and use of Equipment, and that he/she can minimize his/her risk of injury by following such rules, exercising common sense and by being aware of his/her surroundings at all times.

If, while participating in the Activities, the Participant or his/her parent(s) or legal guardian(s) observe any unusual hazard or condition which they believe jeopardizes Participant’s personal safety or that of others, Participant and/or his/her parent(s) or legal guardian(s) have the duty to remove Participant from participation in the Activities or use of Equipment, and immediately bring such hazard or condition to the attention of the Host.

To the extent that any portion of this Agreement is deemed to be invalid under the law of the applicable jurisdiction, the remaining portions of the Agreement shall remain binding and available for use by the Host and its counsel in any proceeding.
I HAVE READ AND UNDERSTAND THIS AGREEMENT AND I AM AWARE THAT BY SIGNING THIS AGREEMENT I MAY BE WAIVING CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE.
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Participant Signature*

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Participant Name*

First NameLast Name
If participant is a minor, please include Parent/Guardian Signature

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Parent/Guardian Name

First NameLast Name
Today's Date*

MonthDayYear
Date
Should be Empty: