• This form is required for participation in NRLT events and must be completed within 24 hours prior to the event date.
  • I, * (hereinafter I, PARTICIPANT or PARENT), individually and on behalf of * (hereinafter CHILD) HEREBY WAIVE AND RELEASE, indemnify, hold harmless and forever discharge the New River Land Trust, a Virginia non-stock corporation and a tax exempt organization under Section 501(c )(3) of the U.S. Internal Revenue Code, (hereinafter NRLT) and its agents, managers, employees, officers, directors, affiliates, successors and assigns, of and from any and all claims, demands, debts, contracts, expenses, causes of action, lawsuits, damages
    and liabilities, of every kind and nature, whether known or unknown, in law or equity, that I or CHILD ever had or may have, arising from or in any way related to the PARTICIPANT and CHILD'S participation in any of the events or activities conducted by, on the premises of, or for the benefit of, NEW RIVER LAND TRUST provided that this waiver of liability does not apply to any acts of gross negligence, or intentional, willful or wanton misconduct.

    I recognize and acknowledge that there are risks associated with such aforementioned program(s)/event(s), which may include but are not limited to: falls, contact with other participants, the effects of weather, misuse or failure of equipment, uneven ground, poisonous plants, wild life contact and other dangers which could cause injury or death. I waive all claims that I might have based on any of those and other risks typical in this type of activity. I authorize the NRLT and its program coordinator or staff/volunteers, in event of an accident or illness affecting said CHILD, to authorize on my behalf all procedures, including admission to hospital and necessary treatment, as he/she may deem essential for the care and well-being of said participant, in the event that immediate contact with the undersigned cannot be made.

    I am aware staff/volunteers may provide support for this program/event, including but not limited to the administration of: first aid, CPR (Cardiopulmonary resuscitation), and/or the use of an AED (automated external defibrillator). I authorize any such staff/volunteers to assist me (or my child/ward) and/or to provide such assistance as in the opinion of such person may be necessary or appropriate. I understand that neither NRLT, nor any of its supporting sponsors, assume any responsibility or liability with respect to my or my CHILD's participation in this event/program. I agree and hereby waive (on behalf of PARTICIPANT and CHILD) all claims against, and agree to fully release, hold harmless, and indemnify NRLT, all sponsors, representatives (including staff/volunteers), and independent contractors from all claims or liabilities of any kind arising out of my participation in this event/program, even though liability may arise out of negligence or carelessness on the part of the persons named in this waiver. I
    further agree and warrant that if at any time I believe conditions to be unsafe, I will immediately exercise my parental/guardianship rights and discontinue further participation by CHILD in the activity.

    By indicating your acceptance, you understand, agree, warrant and covenant for
    PARTICIPANT and, if applicable, for your CHILD, as follows (if the participant is under 18 years of age, the parent/guardian must sign). This WAIVER AND RELEASE contains the entire agreement between the parties, and supersedes any prior written or oral agreements between them concerning the subject matter of this WAIVER AND RELEASE. The provisions of this WAIVER AND RELEASE may be waived, altered, amended or repealed, in whole or in part, only upon the prior written consent of all parties. The provisions of this WAIVER AND RELEASE will continue in full force and effect even after the termination of the activities conducted by, on the premises of, or for the benefit of, NRLT whether by agreement, by operation of law, or otherwise.

    I have read, understand and fully agree to the terms of this WAIVER AND RELEASE.
    I understand and confirm that by signing this WAIVER AND RELEASE said CHILD and I have given up future legal rights. I have signed this Agreement freely, voluntarily, under no duress or threat of duress, without inducement, promise or guarantee being communicated to me.

    My signature is proof of my intention to execute a complete and unconditional WAIVER AND RELEASE of all liability to the full extent of the law.

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  • Health History and Emergency Contact Information

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  • I HEREBY CERTIFY THAT THE INFORMATION PROVIDED HEREIN IS ACCURATE TO THE BEST OF MY ABILITY AND KNOWLEDGE

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