Pile burning

Personal or Parent-Guardian Release Forms

This form is required to participate in the community pile burning events and classes at Pacifica
Greetings Community Members,

Thank you for your interest in joining Pacifica's Pile and Precribed Burn Workshops. This is one event in a series of interagency events to reintroduce ecological and cultural fire to the restoration and steawrdship efforts at Pacifica. We are especially excited about the rich community building aspects of fire and look forward to being fire side with you.

Please complete the form below to register yourself, student or family for the Intro to Prescribed Burns class on March 7th 10 am to 2pm. We will meet in front of the Cedar Center (the main building) in the Pavillion.

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If you plan to attend as a family please list all family members this waiver applies to
Name each participant in your family.
NAME OF PARENT OR GUARDIAN COMPLETING THE WAIVER (Your Name if over 18)*

First NameLast Name
NAME OF PARTICIPANT (CHILD/DEPENDENT)

First NameLast Name
You can not drop off a child, if your child is 16 years or older and attending without parent or guardian supervision they must have their own transportation. Events sometimes end early or run late and students need to have transportation on site.

Yes, I will be attending the event with my childNo, I will NOT be attending the event with my child and they have their own transportation.
Phone Number
Please enter a valid phone number.
Email
example@example.com
Emergency Contact Information

Please use an additional emergency contact. The parent or guardian completing this form will automatically be listed as a emergency contact, if you are not available who can we contact in case of an emergency?
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Please notify this emergency contact of your students training and Outdoor School dates and that they are listed as a secondary emergency contact.
Are you able to contribute warm food to volunteers? If yes, please let us know what you plan to bring and for how many people.
ACKNOWLEDGEMENT of RISK and RELEASE from LIABILITY

ACCEPTANCE of RISK and RESPONSIBILITY

I am aware that this event or activity may entail risk of injury to myself or my dependent, to spectators and to third parties. I expressly agree, covenant and promise to accept and assume all responsibility and risk or any damage to myself, my dependents, or my property arising from our participation in activities at Pacifica. I decide to participate in and/or allow my child/dependent to participate in these activities in spite of the stated risks.

RELEASE and DISCHARGE of LIABILITY

I, the undersigned, hereby acknowledge that I have read the assumption of risk statement and fully understand there may be certain elements of risk inherent in outdoor or indoor activities which are beyond the control of the instructors, staff, agents, officers, and employees of Pacifica.

In consideration of Pacifica furnishing services to enable myself or my dependent to participate, I hereby assume all risk to myself or my dependent or damage to property arising out of participation in this activity, including hazards associated with any defect in a manufacturer’s product. I hereby specifically and voluntarily release Pacifica from any and all liability, including negligence (active or passive), demands or actions as to any right of action or claim to relief which may accrue to me as a result of participation in outdoor and indoor activities.

I further agree, promise and covenant to hold harmless and indemnify Pacifica from all litigation costs, including attorney fees, or from any costs incurred in connection with claims for bodily injury or property damage which I may negligently or intentionally cause to spectators or third parties in the course of my participation.

I further understand Pacifica carries no medical insurance for the protection of participants in outdoor recreation activities and any insurance coverage existing with respect to Pacifica shall not alter the terms of this waiver nor impose any liability on Pacifica.

ACKNOWLEDGEMENT of EFFECT of RELEASE

I understand and acknowledge that by signing this release I have agreed not to assert legal claims, which I might otherwise possibly assert to maintain against Pacifica, based on my or my dependent’s participation in an activity. I also understand and acknowledge that by signing this release I assume full responsibility and legal liability for the claims or other legal demands, including litigation costs, which may be asserted by spectators or other third parties against me as a result of my or my dependent’s participation.

I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS.

I AM AWARE THIS A RELEASE OF LIABILITY AND I SIGN IT OF MY OWN FREE WILL.
MEDIA RELEASE FORM

Photographs and videos will be taken of volunteers and activities. This media may be used in advertisements or social media posts to showcase the fun activities that Pacifica has to offer and community offerings. Please read and fill out the media release below.

Personally identifiable information, including a student’s photograph, participation in program activities, video appearances, and receipt of awards, may be occasionally used or released as part of the Pacifica Outdoor School program. Use or release may include a child’s name, picture,and/or video appearing in Pacifica Outdoor School materials prepared for the purpose of informing the community about the Outdoor School. Pacifica Outdoor School materials may discuss some aspect of the program or may request the donation of tools, games or other materials from community citizens. Use or release also includes our website, news stories in print, social media or television media.

I give my permission for directory information release as stated above. I give my permission for photos and/or videos to be taken of my child.
I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS.

I AM AWARE THIS A RELEASE OF LIABILITY AND I SIGN IT OF MY OWN FREE WILL.

I HAVE DISCUSSED THE STUDENT BEHAVIORAL AGREEMENT WITH MY CHILD/DEPENDENT AND BELIEVE THAT MY STUDENT CAN AND WILL BEHAVE ACCORDINGLY.
Name of Person Completing the Waiver (Parent/Guardian for students under 18)

First NameLast Name
Signature

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Personal or Parent-Guardian Release Forms

Emergency Contact Information