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PHILADELPHIA ORCHARD PROJECT WAIVER OF LIABILITY AND EXPRESS ASSUMPTION OF RISK (PLEASE READ CAREFULLY)

I understand that visiting, planting or maintaining orchards involves inherent risks, including but not limited to the risks of injury or infection as a result of contact with detritus found on the site or due to over-exertion or environmental conditions. I hereby personally assume all risks in connection with the Event for any harm, injury or damage that may befall me as a participant. I understand that the terms herein are contractual, that this instrument is legally binding, and that I have signed this document of my own free will.

By signing this waiver I exempt and release the Philadelphia Orchard Project (POP) from all liability or responsibility whatsoever for personal injury, property damage or wrongful death arising out of participation in this activity, including both claims arising during the activity or after I complete the activity and claims of negligence, whether passive or active, of POP. 

I hereby certify that I fully informed myself of the contents of the POP Waiver by reading it before I sign it on behalf of myself & my heirs, and that I am consequently aware of the inherent hazards of planting & maintaining urban orchards. 

This waiver shall be effective at all POP orchards, from the date of signature until December 31, 2023. (In other words, participants are requested to sign this waiver once per season for participation in POP events)

Photo/video release: I grant POP the right to take photographs and video of me during the activity identified above. I authorize POP to copyright, use and publish the same in print and/or electronically. I agree that POP may use such photographs and video of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. Note: If you do not want to be photographed or filmed, please indicate when you sign the form below.

COVID-19 Waiver and Release

COVID-19 is a contagious virus that spreads easily through person-to-person contact. Federal authorities and the State of Pennsylvania recommend social distancing to prevent the spread of COVID-19. Contracting COVID-19 can lead to severe illness, personal injury, permanent disability, and death. Use of POP facilities or participation in POP programs could increase the risk of you or your child contracting COVID-19.

I have read the above notice carefully and acknowledge receipt of a copy thereof. In consideration of the benefits received, I understand and appreciate the risks that are inherent in using POP facilities and/or participating in POP programs, and hereby assume all risks of illness, including death, that I may sustain while participating in or as a result of, or in any way growing out of the use of POP facilities and/or the participation in POP programs. I hereby assert that my use and/or participation is voluntary and that I knowingly assume all such risks. I hereby agree to release and forever discharge POP, and its officers, agents and employees of any and from all claims, demands, rights and causes of action of whatever kind or nature, arising from and by reason of any and all known and unknown, foreseen and unforeseen illness, and the consequences thereof, resulting from or an any way connected to any use of POP facilities and/or participation in POP programs.

I HAVE READ AND UNDERSTOOD THE FOREGOING ACKNOWLEDGMENT OF RISK, ASSUMPTION OF RISK AND RESPONSIBILITY, AND RELEASE OF LIABILITY. I UNDERSTAND THAT BY SIGNING THIS FORM I MAY BE WAIVING VALUABLE LEGAL RIGHTS.



First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Information
Community Orchard Location*

Event date *

Home Zip Code *
Photos/Video okay?*
Yes
No
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information
Community Orchard Location*

Event date *

Home Zip Code *
Photos/Video okay?*
Yes
No
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information
Community Orchard Location*

Event date *

Home Zip Code *
Photos/Video okay?*
Yes
No
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information
Community Orchard Location*

Event date *

Home Zip Code *
Photos/Video okay?*
Yes
No
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information
Community Orchard Location*

Event date *

Home Zip Code *
Photos/Video okay?*
Yes
No
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information
Community Orchard Location*

Event date *

Home Zip Code *
Photos/Video okay?*
Yes
No
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information
Community Orchard Location*

Event date *

Home Zip Code *
Photos/Video okay?*
Yes
No
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information
Community Orchard Location*

Event date *

Home Zip Code *
Photos/Video okay?*
Yes
No
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information
Community Orchard Location*

Event date *

Home Zip Code *
Photos/Video okay?*
Yes
No
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information
Community Orchard Location*

Event date *

Home Zip Code *
Photos/Video okay?*
Yes
No
Participant's Address
Address Line 1:
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:
City:
State/Province:
Zip/Postal:
Parent or Guardian's Email Address

Email*
Sign up for POP's Volunteer & Events email list
A signed copy of this waiver will be sent to the email address you provide.
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 Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information
Community Orchard Location*

Event date *

Home Zip Code *
Photos/Video okay?*
Yes
No
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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