Ephemeral Eco Art Registration Form

Ephemeral Eco Art Registration Form

Join us for a hands-on outdoor experience in nature where we’ll create beautiful, temporary art from natural materials.This event takes place on a working farm — safety guidelines and waivers are required. Ages 16+ may attend without a guardian. Under 16 must be accompanied by an adult.📍 16749 County Rd. 15, Moose Creek, ON🗓️ October 18th, 1-4pm. Fill out this form to register!
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Will you be bringing minors under the age of 16?
If yes, Please enter names and ages of minors attending.
Emergency Contact

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to You
Do you or anyone attending have allergies, medical conditions, or accessibility needs we should know about?
My Commitment

I agree to:
- Take care of my own safety and that of others while participating.
- Follow instructions from organizers and respect the land, wildlife, and farm environment.
- Take suitable precautions against ticks, including:
  ☐ Wearing long pants and sleeves and close-toed shoes.
  ☐ Using insect repellent.
  ☐ Staying on paths where possible.
  ☐ Doing a tick check after the event.
Acknowledgement of Risks
- I understand that outdoor activities may involve exposure to natural elements, including insects such as ticks. I agree to take the precautions listed above and make sure any children who accompany me do the same.
- I understand that there are farm animals on the property, including horses and ponies, and that their behavior may be unpredictable. I agree not to feed, pet, or approach them or to enter their field, unless supervised by a member of the Butternut Creek team.
- I understand that, as with any outdoor activity, there are inherent risks which include but are not limited to tripping and falling, uneven ground, ticks, and weather conditions.
- I understand that if I choose to go on the wagon ride there are risks included but not limited to falling or tripping when getting on and off, jarring and bouncing.
Release & Indemnity

By signing below, I agree to participate at my own risk. I affirm that I have read and understood this waiver, and I release and hold harmless Butternut Creek Nature Reserve Foundation and Butternut Creek Farm, its owners, board, staff, and volunteers from any claims, liability, or damages that may arise from my participation, or from the participation of any children who accompany me, in this event.

In the case of a minor under the age of 18, I affirm that I am the parent or legal guardian of the minor named on this form. I have read and understood this waiver, and I give permission for my child to participate in the Ephemeral Art Activity at Butternut Creek under the above terms.
Type your full name to serve as your digital signature.
If you are under 18, a parent or guardian must type their full name here as a digital signature.
Signature (If over the age of 18)
Should be Empty: