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708 Smokey Bay Way, Homer, AK 99603 

(907) 235-6667

info@akcoastalstudies.org

Enrollment and Permission Form
CACS Camps & Programs

I understand the program will be conducted at the Peterson Bay Field Station, Wynn Nature Center, CACS Yurt on the Spit, and CACS Headquarters by trained naturalists on the CACS staff and CACS volunteers.

PARENT/GUARDIAN PERMISSION FORM

PARENT/GUARDIAN AUTHORIZATION: I hereby declare my child to be physically sound, having medical approval to participate in the activities of CACS. This is correct so far as I know, and the person  herein  described  has permission  to  engage  in  all  prescribed  activities  except  as  noted.   I   further  understand   that  the Center for Alaskan Coastal Studies nor any of  its  paid  staff  or  volunteers  can  be  held  responsible in  the  event of an accident. I also certify that my child will be a positive contributor to the activities and group. 

I Agree

TRANSPORTATION AGREEMENT: I understand that my child will be using van and/or boat transportation for camps and programs. I give permission for my child to travel by the above methods with Center for Alaskan Coastal Studies staff. I undertsand that only licensed and qualified personnel will operate any vehicle to and from sites, and there will be at least one staff member present at all times. I agree to release the Center for Alaskan Coastal Studies staff from any and all claims of damages, demands, or liabilities, which may arise as a result of my child's participation on these trips.

WILD EDIBLE AGREEMENT: I grant my permission for my child to participate in the safe tasting of  wild edibles while participating in this program. I understand that my child may be tasting wild  plants  that  may include, but is not limited to, blueberries, watermelon berries,  crow  berries,  salmon  berries,  wild  currant, trailing raspberry, chocolate lily bulbs, fireweed, oyster leaf, beach  greens,  wild  violet,  wild  geranium, dandelion leaves, lovage, wild  mustard,  wild  rose,  wild  onion/chive,  sorrel,  and  beach  plantains.  I  know of no known  allergies  that  my child  has to  any  of  these  plants  or other foods.

I Agree

EMERGENCY AUTHORIZATION: I authorize any representative of the Center for Alaskan Coastal Studies to seek medical attention for my child when immediate medical care is warranted by the circumstances and I cannot be reached, or if under the circumstances there is not time to attempt to reach me  because of  the nature of the injury or illness. I further authorize the health care professional selected by the agency  to provide the necessary care and treatment for my child. / give consent for emergency treatment to be administered to my child if necessary. 

I Agree

RELEASE: In consideration of my child's participation in the CACS activities, I do hereby agree to hold free from any and all liability the agencies (CACS) and its respective offices, employees, and members and do hereby for myself, my heirs, executors and administrators, waive, release, and forever discharge any and all rights and claims for damages which I may have or which hereinafter accrue to me arising out of or connected with my child's participation in any of the  activities of CACS.

I Agree

I give permission for the use of photographs, videos or audio clips including my child for the Center for Alaskan Coastal Studies.

I Agree

I have read all information and give consent for my child to participate in the program conducted by the Center for Alaskan Coastal Studies.

Today's Date: November 19, 2024

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Gender

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First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Gender

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Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Gender

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Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Gender

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Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Gender

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Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Gender

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Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Gender

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Eighth Participant's Name

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Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Gender

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Ninth Participant's Name

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Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Gender

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Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Gender

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Participant's Address
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Street address, P.O. box, company name, c/o
Address Line 2:
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Parent or Guardian's Email Address

Email
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Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Insurance

Insurance Carrier*

Insurance Policy Number*
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.


By signing below the parent or court-appointed legal guardian agrees that they are also 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*
Parent or Guardian's Gender

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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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