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Consent and Release Agreement

In consideration of permission to participate in, or continue participating in, the activities and programs of Nature Reliance School and to use its facilities, I hereby acknowledge and agree as follows:

 

I understand that my participation in programs offered by Nature Reliance School, LLC is purely voluntary.  I recognize that the program is designed to use experiential, engaging, teaching techniques.  At all times, I will choose my level of participation in any activity.  Further, I agree that I must comply with requests, directions and instructions of the individuals offering programs and my failure to do so may result in my removal from the program.  I agree that I will use and wear the appropriate safety equipment, and follow all recommended safety recommendations.

 

I recognize that my participation in Nature Reliance School, LLC programs is with some risk of bodily injury.  I accept those risks and full knowledge of the dangers involved (including but not limited to:  increased heart rate, blood pressure, strained or sprained muscles, fractured bones, partial or complete paralysis, heart attacks, psychological injury, death or possibility of other serious injury), and hereby certify that I know of no physical or medical problems that would increase my risk of illness or injury, as a result of participating in Nature Reliance School programs. 

 

In the event of an injury or sudden illness, I consent to the administration of first aid and resuscitative measures performed on my behalf by trained or qualified personnel.  I assume full responsibility for all medical expenses incurred as a result of injuries suffered by my participation in Nature Reliance School, LLC programs.

 

I hereby release and discharge Nature Reliance School, LLC its agents, employees, representatives, students the building and ground owners, any related entities, and all others from any and all liability, responsibility, loss, damage, costs, claims, and causes of arising out of or resulting from my use of or presence upon these facilities and/or participation in Nature Reliance School, LLC programs, specifically including, but not limited to, any all liability, responsibility, loss, damage, costs, claims, and/or causes of action that arise from or are caused by the negligence or fault of Nature Reliance School, LLC, its agents, employees, representatives, the building and grounds owners, any related entities, or other participants in the Nature Reliance School, LLC programs.

 

Furthermore, I am aware that photos of our activities and my participation in them may be used for current and future promotional activities. I understand that if I do not want photos of me taken, I will make that known before events begin.  

 

I have read the entire Consent and Release Agreement and accept the conditions stated herein as a requirement for my participation in Nature Reliance School programs.

 

July 19, 2024

 

 

First Participant's Name

First Name*

Last Name*
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 Emergency Contact Info

Emergency Contact Name

Emergency Contact Phone Number
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Emergency Contact Info

Emergency Contact Name

Emergency Contact Phone Number
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Emergency Contact Info

Emergency Contact Name

Emergency Contact Phone Number
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Emergency Contact Info

Emergency Contact Name

Emergency Contact Phone Number
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Emergency Contact Info

Emergency Contact Name

Emergency Contact Phone Number
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Emergency Contact Info

Emergency Contact Name

Emergency Contact Phone Number
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Emergency Contact Info

Emergency Contact Name

Emergency Contact Phone Number
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Emergency Contact Info

Emergency Contact Name

Emergency Contact Phone Number
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Emergency Contact Info

Emergency Contact Name

Emergency Contact Phone Number
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Emergency Contact Info

Emergency Contact Name

Emergency Contact Phone Number
Parent or Guardian's Email Address

Email
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*
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 Emergency Contact Info

Emergency Contact Name

Emergency Contact Phone Number
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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