2022/2023 Nature Connection Programs Waiver and Release

Program Waiver- The Nature Connection 2022-2023

Permission to participate in activities
Program *
Please select from the following options. If you are not sure, select "Other"
Participant's Full Name *

First Name Last Name
Participant's Age *
Participant is a minor

Yes No
Participant's Gender

Female Male Other Preference
School
Liability Release

Please read and sign for the participant
In consideration of being allowed to participate in any way in the listed camp or seminar, related events and activities, I, the undersigned, acknowledge, appreciate and agree, for myself or on behalf of my child, that:

1. While particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist and that risk of injury from the activities involved in these programs is significant, including the potential for permanent injury and/or death; and

2. I knowingly and freely assume all such risks, both known and unknown, and assume full responsibility for my own or my child’s participation; and

3. I willingly agree that I or the listed child will be instructed to comply with the stated and customary terms and conditions for participation. I will instruct my child, however, if they observe any unusual significant hazard during their presence or participation, they should remove themselves from participation and bring such to the attention of the nearest official immediately; and

4. I understand that if I choose to drive a child in my own vehicle or allow them to be a passenger in a non-DCSD vehicle while traveling to and/or from a seminar, camp, or club event or activity, DCSD automobile liability insurance coverage will not apply; and

5. I accept responsibility for the use, by my child, of equipment provided through The Nature Connection and accept full responsibility for the care of the equipment while it is in the possession of my child. I understand that the group leader has examined the equipment and accepted it as is. I agree that I or my child will return the equipment in good repair. I agree that any losses or damages beyond normal wear and tear will be paid for according to the extent of the damages.

6. I, for my child, and on behalf of my child’s heirs, assigns, personal representatives and next of kin, hereby release, indemnify and hold harmless The Nature Connection/ Delta County School District, their officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used to conduct the event or activity (“Releases”) with respect to any and all injury, disability, or loss or damage to person or property, to the fullest extent permitted by law.

7. I understand that I am solely responsible for any/all of my child’s medical expenses which are not otherwise covered by health insurance, resulting from his/her participation with The Nature Connection

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS, ON BEHALF OF MY CHILD, BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
Photo Release

Guardian Acknowledgement of Photo Release: I grant permission to the Nature Connection, its agents, and its employees the irrevocable and unrestricted right to produce photographs and video taken of my child, myself, and members of my family while at the Nature Connection for any lawful purpose including publication, promotion, illustration, advertising, trade, or historical archive in any manner or in any medium by the Nature Connection. I hereby release the Nature Connection and its legal representatives from liability for any violation or claims relating to said images or video. Furthermore, I grant permission to use the statements of my child, myself, or my family members given during an interview or evaluation with or without my name for the purpose of advertising and publicity without restriction to time limit or geographic area. I waive my right, my child’s rights, and my family’s rights to any and all compensation stemming from the use of these materials.
NO, my child CANNOT be photographed YES, my child CAN be photographed
Parent/ Guardian Full Name *

First Name Last Name
Mailing Address *

Street Address

Street Address Line 2

City State

Zip Code
Parent/ Guardian E-mail *
Home Phone Number

Area Code Phone Number
Parent/ Guardian Cell Phone Number *

Area Code Phone Number
I, the parent/guardian, hereby attest that I have carefully read this Permission to Participate, understand its contents, and agree to its terms and conditions. *

I agree
Date *

Month Day Year
Signature

Clear
Should be Empty:

Program Waiver- The Nature Connection 2022-2023

Liability Release

Photo Release