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Waiver of Liability and Media Release

Insights El Paso Science Center Inc
4120 Rio Bravo Suite 117, El Paso, TX 79902
info@insightselpaso.org | 915-534-0000

EPA (Environmental Protection Agency) Student-led Environmental Stewardship Initiative (SESI) Program Waiver of Liability and Media Release

I hereby assume all of the associated risks of participating in any and all activities, workshops, and field trips, associated with the EPA (Environmental Protection Agency) Student-led Environmental Stewardship Initiative (SESI) program over the 2021/2022 school year.


I waive, release, and discharge from any and all liability the following entities, parties, or persons for my personal injury, property damage, property theft, death, disability, or actions of
any kind which may hereafter occur to me, including traveling to and from activities.

INSIGHTS EL PASO SCIENCE CENTER, INC.
FRIENDS OF THE RIO BOSQUE
TRANSPECOS AUDUBON SOCIETY
FRONTERA LAND ALLIANCE
WEST TEXAS URBAN FORESTRY COUNCIL
CREOSOTE COLLABORATIVE
UTEP CENTENNIAL MUSEUM AND DESERT GARDENS
PRIVATE ORGANIC FARM OWNERS MARTY LOYA & RALPH LOYA
GREEN HOPE PROJECT
U.S. ENVIRONMENTAL PROTECTION AGENCY
and/or their directors, officers, employees, volunteers, representatives, sponsors, along with any affiliates of the SESI program.

I understand while participating in these activities, I may be photographed. I agree to allow my photo, video, or film likeness to be used for any legitimate purpose by the previously listed entities, parties, or persons.

I CERTIFY THAT I HAVE READ THIS DOCUMENT AND FULLY UNDERSTAND ITS CONTENT.

 

March 26, 2023

This publication was developed under Assistance Agreement No. NE96878101-0 awarded by the U.S. Environmental Protection Agency. It has not been formally reviewed by EPA. The views expressed in this document are solely those of Insights Science Center and the EPA does not endorse any products or commercial services mentioned in this publication.

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First Student's Name

First Name*

Last Name*

Phone*
First Student's Date of Birth*
I certify that I am 18 years of age or older
First Student's Signature*
Parent or Guardian's Email Address

Email*

Confirm Email*
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*

Relationship*

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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