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THIS WAIVER APPLIES TO ALL FRIENDS OF THE BLACK RUN VOLUNTEER OPPORTUNITIES AND EVENTS FOR 1 YEAR FROM SIGNATURE DATE.

Friends of the Black Run Acknowledgement of Risk and Assumption of Personal Responsibility

TODAY'S DATE: September 20, 2018

Friends of Black Run Preserve (FBRP) activities and events provide fun and education for a wide audience. Any field trip or wilderness or semi-wilderness activity has inherent hazards that differ from the hazards we all routinely accept at home, in town or in the suburbs. With this in mind, we ask all of our participants to carefully review the below statements and sign this acknowledgement of risk and assumption of personal responsibility:

I understand that during my participation in a FBRP activity and event, I may be exposed to inclement weather, insects, terrain, water and other risks that are to be expected on field trips and in outdoors and/or wilderness activities.

I understand that it is impossible for FBRP to guarantee absolute safety. I understand that I am responsible for my safety during the activity or event, and I assume that responsibility. I agree to comply with the instructions and directions of the FBRP staff during the activity or event. I accept responsibility to verify with my physician that I have no physical or psychological problems that would prohibit my participation in the activity, and I accept responsibility for conditioning myself to be reasonably prepared for the activities for which I have registered.

By signing this acknowledgment, I (hereinafter collectively referred to as "Attendee"), on behalf of myself, my heirs, representatives, successors and assigns, hereby voluntarily agree to release, waive, discharge, hold harmless, defend and indemnify the Friends of the Black Run Preserve, and its employees, trustees, officers and agents (hereinafter collectively referred to as FBRP), from any and all claims, actions, damages, or losses for bodily injury, property damage,death, loss of services or otherwise (hereinafter collectively referred to as Claims), in any way arising out of my participation in the event, whether or not such Claims are caused by the alleged negligence or gross negligence of FBRP.

INSURANCE. The Attendee understands that, except as otherwise agreed to by FBRP in writing, FBRP does not carry or maintain health, medical, or disability insurance coverage for any Attendee. Each Attendeeis expected and encouraged to obtain his or her own medical or health insurance coverage.

PHOTOGRAPHIC RELEASE. Attendeehereby grants to FBRP and its representatives the right to take photographic images, video and audio recordings of Attendee in connection with Attendeeactivities with FBRP. Attendeedoes hereby grant and convey unto FBRP all right, title, and interest in any and all photographic images, and video or audio recordings made by FBRP during such activities, including, but not limited to, any royalties, proceeds, or other benefits derived from such photographs or recordings. Attendeealso hereby authorizes FBRP to publish any and all images and recordings taken by FBRP staff and volunteers in which Attendee appears, to be used by the FBRP for marketing and public relations purposes.

GOVERNING LAW. Attendeeagrees that this Release shall be governed by and interpreted in accordance with the laws of the State of New Jersey, and that the terms of this Release are intended to be as broad and inclusive as permitted by said laws. Volunteer agrees that in the event that any clause or provision of this Release shall be deemed to be invalid by a New Jersey court of competent jurisdiction, the invalidity of such clause or provision shall not otherwise affect the remaining provisions of this Release which shall remain in full force and effect.

I state that I have carefully read the foregoing Acknowledgement of Risk and Assumption of Personal Responsibility, understand its contents, and sign my name as my own free act, and that by signing Iconsent to the terms of this Acknowledgement.

First Attendee's Name

First Name*

Last Name*

Phone*
First Attendee's Date of Birth*
I certify that I am 18 years of age or older
First Attendee's Signature*
Second Attendee's Name

First Name*

Last Name*

Phone*
Second Attendee's Date of Birth*
Third Attendee's Name

First Name*

Last Name*

Phone*
Third Attendee's Date of Birth*
Fourth Attendee's Name

First Name*

Last Name*

Phone*
Fourth Attendee's Date of Birth*
Fifth Attendee's Name

First Name*

Last Name*

Phone*
Fifth Attendee's Date of Birth*
Sixth Attendee's Name

First Name*

Last Name*

Phone*
Sixth Attendee's Date of Birth*
Seventh Attendee's Name

First Name*

Last Name*

Phone*
Seventh Attendee's Date of Birth*
Eighth Attendee's Name

First Name*

Last Name*

Phone*
Eighth Attendee's Date of Birth*
Ninth Attendee's Name

First Name*

Last Name*

Phone*
Ninth Attendee's Date of Birth*
Tenth Attendee's Name

First Name*

Last Name*

Phone*
Tenth Attendee's Date of Birth*
Parent or Guardian's Email Address

Email*
Check to receive updates about Black Run Preserve and events by email.
A signed copy of this waiver will be sent to the email address you provide.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
ANY MEDICAL CONDITIONS OR ILLNESSES (select one):*
I DO NOT have any medical condition(s) or illness(es) or regular medications that the FBRP representative should be aware of in the event an emergency arises. I accept full responsibility for any costs incurred by FBRP due to any such condition, illness or medication.
I DO have any medical condition(s) or illness(es) or regular medications that the FBRP representative should be aware of in the event an emergency arises. (If you do, please explain, so we can optimize your safety.) I accept full responsibility for any costs incurred by FBRP due to any such condition, illness or medication.

OPTIONAL: If you have any medical conditions or illnesses you'd like us to be aware of, please explain here.
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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