Release & Waiver of Liability

Participant Name:*

First NameLast Name

Date of Birth*

Date

What event are you attending? Please include date:*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

County*

Participant Home Phone:*

Area CodePhone Number

Participant Cell Phone (If applicable)

Area CodePhone Number

Email (Best to contact):*

example@example.com

Is Participant a Minor?*

(Under 18 years of age)

If Minor, Name of Parent or Guardian:

First NameLast Name

Relation to Participant:

Ex: Mother, Father, Grandparent, Guardian

Participant has voluntarily chosen to participate in activities for recreational or conservation purposes at Gardner Camp. THE UNDERSIGNED IS AWARE THAT THESE ACTIVITIES ARE HAZARDOUS ACTIVITIES AND THAT PARTICIPANT COULD BE SERIOUSLY INJURED OR EVEN KILLED. PARTICIPANT IS AWARE that while participating in Gardner Camp activities, PARTICIPANT may be exposed to animals and that animals may be afflicted with infectious and/or contagious diseases including but not limited to rabies. PARTICIPANT IS also aware that animals may react in an unpredictable way to sounds, sudden movements, people, or other animals that could result in injuries to people including PARTICIPANT.THE UNDERSIGNED AND PARTICIPANT FURTHER ACKNOWLEDGE BEING AWARE OF THE COVID-19 PANDEMIC AND RELATED GOVERNMENTAL ORDERS, DIRECTIVES AND GUIDELINES (COLLECTIVELY “DIRECTIVES”), INCLUDING DIRECTIVES FOR FREQUENT HAND WASHING, SOCIAL DISTANCING AND USE OF FACE COVERINGS IN PUBLIC LOCATIONS. PARTICIPANT IS AWARE THAT THESE ACTIVITIES ARE OCCURRING IN A PUBLIC LOCATION DURING THE COVID-19 PANDEMIC AND MAY THEREFORE BE HAZARDOUS ACTIVITIES. THE UNDERSIGNED AND PARTICIPANT expressly waive all claims for damages, injuries and death sustained to PARTICIPANT that PARTICIPANT may have against Gardner Camp as a result of being exposed to HAZARDOUS ACTIVITIES AND ANIMALS. PARTICIPANT AND THE UNDERSIGNED AGREE TO ASSUME ANY AND ALL RISKS OF BODILY INJURY, DEATH OR PROPERTY DAMAGE, WHETHER THOSE RISKS ARE KNOWN OR UNKNOWN. BY SIGNING THIS DOCUMENT. THE UNDERSIGNED, FOR AND ON BEHALF OF THE PARTICIPANT IS WAIVING ANY AND ALL LIABILITY ACTIONS WHICH PARTICIPANT MIGHT PURSUE AGAINST THE J.W. GARDNER, II DECLARATION OF TRUST DATED OCTOBER 28, 2009, STATE STREET BANK AND TRUST COMPANY, AS SUCCESSOR TRUSTEE OF THE J.W. GARDNER, II DECLARATION OF TRUST DATED OCTOBER 28, 2009, THEIR DIRECTORS, OFFICERS, EMPLOYEES, ADVISORY BOARD, AND AGENTS (COLLECTIVELY, “GARDNER CAMP”) FOR ANY AND ALL BODILY INJURY OR INJURIES, DEATHS, OR PROPERTY DAMAGE, INCLUDING ANY AND ALL LIABILITY ACTIONS ARISING OUT OF NEGLIGENCE ON THE PART OF GARDNER CAMP.

As consideration for being permitted by Gardner Camp to participate in the aforementioned activities, the undersigned and Participant forever release Gardner Camp from any and all actions, claims, or demands that Participant may have now or in the future, for injury, death, or property damage, related to (i) participation in these activities, (ii) the negligence or other acts, whether directly connected to these activities or not, and however caused, by Gardner Camp, or (iii) the condition of the premises where these activities occur or animals that may be encountered on such premises. I also agree that Participant, Participant’s assignees, heirs, distributees, guardians, next of kin, spouse and legal representatives will not make a claim against, sue, or attach the property of Gardner Camp in connection with any of the matters covered by the foregoing release.

By signing this release form, Participant does hereby grant and convey unto Gardner Camp and its assignees all right, title and interest in any and all photographic images and video or audio recordings made by Gardner Camp during Participant’s activities with Gardner Camp, including, but not limited to, any royalties, proceeds, or other benefits derived from such photographs or recordings. Participant expressly consents to the photographing and/or videotaping of Participant’s images and expressly consents to the audiotape recording of Participant’s voice.

PARTICIPANT HAS CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTANDS ITS CONTENTS, IS AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN PARTICIPANT AND GARDNER CAMP, AND SIGNS IT OF PARTICIPANT’S OWN FREE WILL.

Participant Signature (Required if participant is over 18.)

Releasor Parent/Guardian Signature (Required if participant is under 18)

NOTE: If Participant is under 18 years of age, Participant’s parent or guardian must sign and initial this form where indicated. If signed by the Parent or Guardian: I verify that the dangers of the activities and the significance of this Release and Waiver were explained to the parent or guardian and the parent or guardian understood them. The undersigned also understands this form in its electronic form will be printed and/or copied for administrative purposes and the print/copy will serve as the original.

Parent/Guardian Home Phone, if different than above:

Area CodePhone Number

Parent/Guardian Cell Phone, if different than above:

Area CodePhone Number

Parent/Guardian Work Phone (Optional):

Area CodePhone Number

In case of emergency, please contact:*

First NameLast Name

Relation:*

Ex: Parent, Grandparent, Family Friend

Emergency Contact Home Phone:*

Area CodePhone Number

Emergency Contact Cell Phone:*

Area CodePhone Number