IMMP Landowner Waiver & Release of Liability (OUTDATED)

STEP 1. The field observer(s) ("Permittee") enters the Landowner/Representative's name, property address, and email address, signs the form, and submits it using the Submit button at the page bottom. This sends the partially-completed form to the Landowner/Representative's email.

STEP 2. The Landowner/Representative selects the SITE ACCESS AND DATA SHARING PREFERENCES, signs the form, and submits it using the Submit button at the page bottom. This finalizes the waiver.

In consideration for allowing the "Permittee" (see below) and its organization's staff or volunteers to enter "Landowner" (see below) "Property" (see below) SPECIFICALLY and SOLELY for the purposes of monitoring milkweed, nectar plants, and/or monarchs:

Permittee hereby waives all claims against the Landowner for injuries or damages incidental to, connected with, or arising out of Permittee’s access to the Property. Each party shall be responsible for its own acts and behavior and the results thereof.

Permittee understands that entry and access to the Property may be hazardous and that injuries or damages may occur in the normal course of accessing the Property. Permittee assumes all risks and hazards incidental thereto by Permittee’s employees and agents.

The Permittee has permission to enter the Property to collect milkweed, nectar plant, and monarch data at the frequency and duration noted below. No specimens will be collected with the exception of plant material as needed to aid in species identification.

Landowner or Representative Name ("Landowner")*

First NameLast Name

Organization/Agency

If applicable

Property Address ("Property")*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Landowner/Representative Phone Number

Landowner/Representative Email Address*

At what frequency may the Permittee visit the Property to collect milkweed, nectar plant, or monarch data?

WeeklyMonthlyOnceOther

May the Permittee collect a subsample of monarch caterpillars from the Property to rear to adulthood for the purposes of this research? (For California, mark "No.")

YesNo

Landowner agrees to allow monitoring data collected from the Property to be released to researchers via the Integrated Monarch Monitoring Program (www.monarchjointventure.org/immp). No personal information (e.g., name, contact information) will be associated with the monitoring data. Choose the level at which we can associate the biological data - *GPS coordinates option is highly preferred*:

GPS coordinates10 x 10 kilometer blockCounty

Through what date may the Permittee collect monitoring data at the Property?

Date

How should the Permittee contact you, the Landowner, in regard to monitoring visits?

PhoneEmailTextOther

Landowner/Representative Signature

Permittee Name ("Permittee")*

First NameLast Name

Permittee Organization

Permittee Signature*