Workshop/Drop-in Registration and Waiver

Workshop Registration and Waiver

Please complete all required fields. Upon submission, you will receive a confirmation email with additional class details and a link to pay class fees through Give Butter. Please reach out to info@humannatureschool.org with any questions!
Participant Name

First NameLast Name
Nickname
Participant Pronouns
Birthdate of Participant

MonthDayYear
Date
I am registering for:
- Name
  
  First NameLast Name
- Contact Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Contact Email
  example@example.com
- Contact Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Emergency Contact
  
  First NameLast Name
- Emergency Contact Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Relation to Participant
  ie spouse, parent, friend, etc...
- Please let us know if there are any special requests or needs for participation in your selected program! Many programs involve movement, uneven surfaces, and unpredictable weather conditions, but we strive to make programming accessible!
- I give my permission for my child’s photograph or video to be taken for use by the Human Nature School on their website, social media, and/or promotional materials.
- RELEASE, INDEMNIFICATION & WAIVER
- I, the undersigned, hereby acknowledge that I have been advised and fully understand that certain elements of danger are inherent in the activities sponsored by Human Nature School which are beyond the control of the instructors, agents, officers, students, and employees of Human Nature School, and that participation in any program activities may entail unavoidable risk of personal injury, death, and loss of or damage to property.
  
  These risks include, but are not limited to insect and animal bites and stings, forces of nature such as but not limited to lightning, and unexpected extreme weather conditions, and any hazard present in the wilderness, such as but not limited to low lying branches, sharp objects, and slippery surfaces.
  
  I hereby assume all risks of injury and death to those named above and loss of or damage to property arising out of my participation in such activity and I agree to indemnify, hold harmless Human Nature School, its officers, instructors, volunteers, agents, and employees (“Releasees”) from and against all claims arising from any occurrence causing damage or injury to myself or to any party participating in said event or any third parties injured as a result of my actions.
  
  In case of injury, the emergency contact person will be called immediately for their decision on medical treatment. In the event that the emergency contact person is not reachable, I authorize Human Nature School to consent to emergency medical or surgical treatment of the participant and to nonsurgical medical care. Human Nature School will use our best judgment as to what course of action to pursue and will continue to attempt contact to reach the emergency contact.
  
  Our organization will not be responsible for any costs incurred as a result of illness or injury.
  
  Human Nature School and its employees are not responsible for lost or stolen items.
  
  I consent to emergency medical and surgical treatment and to routine, nonsurgical medical care. (If there is religious objection to consenting to receipt of emergency medical or surgical treatment, I must submit a written statement to the effect that the participant is in good health and that the person signing assumes the health responsibility for the participant.)
  
  Prior to signing below, I have read and understand the terms and conditions of this Release, Indemnification, and Waiver, understand by signing below I am waiving certain legal rights I may have against the Releasees, and I agree to subscribe to all the terms and conditions set out above.
- Signature
- Should be Empty:

Workshop Registration and Waiver

RELEASE, INDEMNIFICATION & WAIVER