The Naranja Nation of OC does not share your private information with ANY 3rd party organizations EXCEPT for the Camp Pendleton Marine Base, which requires the Father's legal name, drivers license information, and DoB for admission onto the base for our Annual Sprint Pow-wow at Camp Pendleton.

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Review Naranja Nation of OC Privacy Policy

RELEASE AND WAIVER OF LIABILITY AGREEMENT / CONSENT TO USE OF LIKENESS

Voluntary Participation

I ("Parent participant") as named on this membership form, acknowledge that I and my daughter(s) as named on this membership form have voluntarily applied to participate in the activities of the Naranja Nation, Inc., dba Naranja Nation OC® (“Program”). I understand that my participation in the Program may involve myself and my child(ren) in activities such as, but not limited to: camping events, campfires, archery, horseback riding, canoeing & boating, crafts, model car derby races, parades, riflery, community service, meetings at members’ houses or other locations, swimming, sports of all types, games, field games, hayrides, sled riding, fishing, dances, holiday or theme parties, rock or wall climbing, museums, etc.

Release, Waiver, Indemnification, Hold Harmless, and Assumption of Risk

I AM AWARE THAT THESE ACTIVITIES ARE POTENTIALLY HAZARDOUS ACTIVITIES AND THAT I AND/OR MY CHILD(REN) COULD BE SERIOUSLY INJURED OR EVEN KILLED. PRIOR TO ENGAGING IN ANY STRENUOUS OR POTENTIALLY HAZARDOUS ACTIVITIES, I AND MY CHILD(REN) WILL UNDERGO A PHYSICAL EXAMINATION WITH A PHYISICIAN OF OUR CHOOSING AND RECEIVE MEDICAL CLEARANCE TO PARTICIPATE IN THE AFOREMENTIONED ACTIVITIES. I AND MY CHILD(REN) ARE VOLUNTARILY PARTICIPATING IN THESE ACTIVITIES WITH KNOWLEDGE OF THE DANGER INVOLVED, AND AGREE TO ASSUME ANY AND ALL RISKS OF BODILY INJURY, DEATH OR PROPERTY DAMAGE, WHETHER THOSE RISKS ARE KNOWN OR UNKNOWN. ON BEHALF OF MYSELF AND MY CHILD(REN), AND TO THE FULLEST EXTENT AVAILABLE UNDER THE LAW, I AGREE TO WAIVE ANY AND ALL CLAIMS THAT MAY ACCRUE AGAINST THE PROGRAM AS A RESULT OF OUR PARTICIPATION IN ANY OF THE PROGRAM’S SPONSORED ACTIVITIES, AND AGREE TO HOLD THE PROGRAM HARMLESS FROM ALL SUCH CLAIMS THAT MAY ARISE.

As consideration for being permitted by the Program to participate in these activities, I agree to indemnify and defend the Program against any and all losses, damages, or claims incurred or suffered by the Program as a result of my and my child(ren)’s participation in these activities. I forever release the Program, any affiliated organization, and their respective directors, officers, employees, volunteers, agents, contractors, and representatives (collectively "Releasees") from any and all actions, claims, or demands that I and/or my child(ren), our assignees, heirs, distributees, guardians, next of kin, spouse and legal representatives now have, or may have in the future, for injury, death, or property damage, related to: (i) my and my child(ren)’s participation in these activities; (ii) the negligence or other acts, whether directly connected to these activities or not, and however caused, by any Releasee or (iii) the condition of the premises where these activities occur, whether or not I or my child(ren) are then participating in the activities. I also agree on behalf of myself and my child(ren) that I and/or my child(ren), our assignees, heirs, distributees, guardians, next of kin, spouse and legal representatives will not make a claim against, sue, or attach the property of any Releasee in connection with any of the matters covered by the foregoing release. I understand and acknowledge that in the event I fail to indemnify and defend the Program in violation of this provision, the Program shall have the right to file a claim against me for such defense and indemnity, and be entitled to recover its attorney’s fees and costs of suit incurred therein. I have been advised to seek independent legal counsel of my choosing for the purpose of reviewing this release form. By signing this release form, I am acknowledging that I have, in fact, sought independent legal counsel to review this form, or that I have voluntarily waived my right to do so.

Release and License to Use Image, Name and/or Voice

In addition, I, the undersigned, individually and on behalf of my child, hereby grant Program permission to use, exploit, adapt, modify, reproduce, distribute, publicly perform and display, in any form now known or later developed, my image or visual likeness, my name and/or my voice (the “Personal Information”) as specified in this Release and indicated above, throughout the world, by incorporating it or them into publications, catalogues, brochures, books, magazines, photo exhibits, motion picture films, internet websites, videotapes, and/or other media (the “Works”) or commercial, informational, educational, advertising, or promotional materials relating thereto. I release, and hereby agree to indemnify, defend, and save harmless Program, its agents, employees, licensees and assigns (collectively, “Released Entities”) from any and all claims I, or any third party, may have now or in the future for invasion of privacy, right of publicity, copyright infringement, defamation or any other cause of action arising out of the use, exploitation, reproduction, adaptation, distribution, broadcast, performance or display of the Personal Information. I waive any right to inspect or to approve any Works that may be created using the Personal Information and waive any claim with respect to the eventual use to which the Personal Information may be applied. The Personal Information may be used at Program’s sole discretion, with or without my name or with a fictitious name, and with fictitious or accurate biographical material, alone or in conjunction with any other material of any kind or nature except that Program will not use the Personal Information for any criminal or illegal purposes or in a manner inconsistent with community standards of decency. I understand and agree that Program is and shall be the exclusive owner of all right, title, and interest, including copyright, in the Works, and any commercial, informational, educational, advertising, or promotional materials containing the Materials. I am of full legal age and have read this release and am fully familiar with its contents. By their signature below, a minor’s parent(s) or legal guardian(s) indicate, on behalf of their minor child, their full and unqualified consent to the terms of this Release & License.

Non-Refundable Nature of Payments and Promise to Pay

Finally, I understand that  the Program negotiates deals with vendors, hosts, sites, etc. based on membership numbers and payments I make.  Attendance does not affect the cost of the Program.  I understand that I have the option to make a one-time payment for the year starting September for my membership or sign up for a monthly subscription.  If I sign up for the subscription, I authorize the Program to charge a one-time initiation fee of $199 and the posted monthly membership rates ($99 for 1Dad&1Daughter, or $129 for 1Dad&2+Daughters) at the beginning of every month until cancellation.  At any time I may contact the Program and provide notice to cancel my membership, which will cancel your membership 30 days after that notice.  If my credit card on file does not pay the dues for any reason, I will promptly update my card when requested by the Program administrator.  If the Program is charged any fees by the payments vendor for any reason relating to my non-payment, I agree that the Program may charge me the cost of those fees. 

I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN MYSELF AND PROGRAM AND SIGN IT OF MY OWN FREE WILL. I verify that the dangers of the activities and the significance of this Release and Waiver were explained to me as the Participant and that I understood them.

November 22, 2019

First Participant Name

First Name*

Last Name*
First Participant Date of Birth*
I certify that I am 18 years of age or older
First Participant Signature*
Second Participant Name

First Name*

Last Name*
Second Participant Date of Birth*
Third Participant Name

First Name*

Last Name*
Third Participant Date of Birth*
Fourth Participant Name

First Name*

Last Name*
Fourth Participant Date of Birth*
Fifth Participant Name

First Name*

Last Name*
Fifth Participant Date of Birth*
Sixth Participant Name

First Name*

Last Name*
Sixth Participant Date of Birth*
Seventh Participant Name

First Name*

Last Name*
Seventh Participant Date of Birth*
Eighth Participant Name

First Name*

Last Name*
Eighth Participant Date of Birth*
Ninth Participant Name

First Name*

Last Name*
Ninth Participant Date of Birth*
Tenth Participant Name

First Name*

Last Name*
Tenth Participant Date of Birth*
Dad's Email Address

Email
A signed copy of this waiver will be sent to the email address you provide.
I represent that I am the parent or legal guardian of the above individual(s) ("Minor(s)") and hereby consent to their use of Naranja Nation facilities and/or participation in activities. In consideration of Naranja Nation allowing the above listed Minor(s) to participate and/or use Naranja Nation facilities, I acknowledge I am familiar with and consent and agree to be bound by the terms and conditions of this Release. The Minor or Minors' participation in activities at Naranja Nation facilities or affiliated events is purely voluntary, and the Minor or Minors elect to participate in spite of the risks. I certify that I and the Minor(s) have adequate insurance to cover any injury or damage the Minor(s) may cause or suffer while participating, or else I agree to bear the costs of such injury or damage myself. I further certify that the Minor or Minors have no medical or physical conditions that could interfere with their safety, or else I am willing to assume and bear the costs of all risks that may be created, directly or indirectly, by any such condition. I, on behalf of myself and the above-named participant(s), hereby agree to waive and release, indemnify, hold harmless and forever discharge the Released Parties, of and from any and all claims, demands, debts, contracts, expenses, causes of action, lawsuits, damages and liabilities, of every kind and nature, whether known or unknown, in law or equity, that said Minor(s) or I ever had or may have, arising from or in any way related to their participation in activities in connection with the Released Parties, provided that this waiver of liability does not apply to any acts of gross negligence, or intentional, willful, or wanton misconduct. I have had the opportunity to ask questions about this document. By signing this document, I acknowledge that if anyone is hurt or property is damaged during said Minor or Minors' participation in activities at Naranja Nation facilities or involving Naranja Nation, I and the Minor(s) may be found by a court of law to have waived the right to maintain a lawsuit against Naranja Nation or any of the other Released Parties on the basis of any claim from which I or the Minor(s) have released them herein. I further agree to indemnify, hold harmless and defend the Released Parties from and against any loss, damage, liability, expense, costs, and/or attorneys’ fees, including any of those brought by me or on behalf of, or otherwise related to or caused by the above-named participant.
Dad's Name

First Name*

Last Name*
Dad's Date of Birth*
I certify that I am 18 years of age or older
Dad'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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