Critter Conservancy LLC
Participant Waiver, Release of Liability & Photo/Video Consent Form
(717) 538-6352 | programs@critterconservancy.com | critterconservancy.com
Thank you for participating in a Critter Conservancy LLC program! Please read this form carefully and completely before signing. By signing, you acknowledge that you have read, understood, and agreed to all terms below. A parent or legal guardian must sign on behalf of any participant under the age of 18.
Section 1: Participant Information
Participant Full Name:
Date of Birth:
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Month
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Day
Year
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Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
City:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
State / ZIP:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number:
Format: (000) 000-0000.
Email Address:
example@example.com
Program Name
Please Select
Backyard Biodiversity
Powerful Pollinators
Nature the Nourisher
Date
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Month
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Day
Year
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Venue / Location:
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Section 2: Parent / Guardian Information (Required for Minors Under 18)
If the participant is under 18 years of age, a parent or legal guardian must complete this section and sign on the participant's behalf.
Parent / Guardian Full Name:
Relationship to Participant:
Phone Number:
Format: (000) 000-0000.
Email Address:
example@example.com
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Section 3: Waiver & Release of Liability
I understand and acknowledge the following:
Critter Conservancy LLC programs involve hands-on educational activities. Participation involves inherent risks including but not limited to outdoor environmental conditions and physical activity.
I agree to follow all instructions provided by Critter Conservancy staff at all times during the program.
I agree to supervise any minor participant in my care and ensure they follow all program guidelines and safety protocols.
In consideration of being permitted to participate in this Critter Conservancy LLC program, I, on behalf of myself and/or the minor participant named above, hereby agree to release, waive, discharge, and hold harmless Critter Conservancy LLC, its owner, employees, and representatives from any and all liability, claims, demands, actions, or causes of action arising out of or related to any loss, damage, injury, or illness that may be sustained during or as a result of participation in this program, including travel to and from the event.
Participant/Guardian Initials:
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Section 4: Photo & Video Consent
Critter Conservancy LLC may photograph or video record programs for use on our website, social media platforms (Facebook, Instagram, YouTube, TikTok, Ko-fi), and other promotional materials. We are committed to participant privacy and make every effort to avoid capturing identifiable facial images of participants — particularly children. Images may capture general program activity including hands, body movement, and environmental context.
Please select ONE of the following:
YES - I consent to Critter Conservancy LLC photographing and/or video recording this participant for use in educational and promotional materials as described above. I understand that every effort will be made to avoid capturing identifiable facial images of participants.
NO - I do NOT consent to Critter Conservancy LLC photographing or video recording this participant. I understand that Critter Conservancy staff will make reasonable efforts to exclude this participant from photos and videos during the program.
I understand that I will not receive compensation for the use of any photos or videos in which I or the minor participant may appear, and that Critter Conservancy LLC retains all rights to approved images.
Participant/Guardian Initials:
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Section 5: Emergency Medical Information
In the event of a medical emergency, Critter Conservancy staff will contact 911 and attempt to reach the emergency contact listed below. Please provide any relevant medical information.
Emergency Contact Name:
Relationship to Participant:
Emergency Contact Phone:
Format: (000) 000-0000.
Known Allergies (including animal allergies):
Medical Conditions or Special Considerations Staff Should Know:
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Section 6: Acknowledgement & Signature
By signing below, I confirm that:
I have read this entire form and understand its contents
I agree to the waiver and release of liability outlined in Section 3
I consent to or decline photo/video use as indicated in Section 4
If signing on behalf of a minor, I am the legal parent or guardian of the participant named above and have the authority to sign this form
Adult Participant OR Parent/Guardian Signature:
Date
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Month
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Day
Year
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Printed Name:
Critter Conservancy LLC | (717) 538-6352 | programs@critterconservancy.com | critterconservancy.com
Protecting native species through conservation and education.
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