KERN RIVER CONSERVANCY SOUTHERN SIERRA CONSERVANCY WAIVER OF LIABILITY AND ASSUMPTION OF RISKS

KERN RIVER CONSERVANCY /SOUTHERN SIERRA CONSERVANCY WAIVER OF LIABILITY AND ASSUMPTION OF RISKS

I understand and agree as follows: 1. I am volunteering my services for KERN RIVER CONSERVANCY; 2. I will perform only those tasks assigned, observe all safety rules, and use reasonable care in the performance of my assignments; 3. I acknowledge that I am engaging in this activity as a volunteer and not as an employee, agent, official, officer or representative, and further acknowledge that I am not entitled to any compensation, benefit or insurance coverage from Kern River Conservancy, Southern Sierra Conservancy, the State of California, the Department of Parks and Recreation, the United States Forest Service, Bureau of Land Management, Kern County Public Works, Kern County Parks, or any agent thereof including any Event promoter, sponsor, or organizer.

I understand and agree that Event Sponsors/organizers and their respective employees, officers, agents or assigns (collectively referred to as “Released Parties”), are not to be held liable or responsible in any way for any injury, death or other damages to me or my family, heirs, or assigns that may occur as a result of my participation in the Event, or as a result of product liability or the negligence, whether passive or active, of any party, including Released Parties, in connection with the Event. Released Parties include, but are not limited to, the following:

KERN RIVER CONSERVANCY, SOUTHERN SIERRA CONSERVANCY, UNITED STATES FOREST SERVICE, BUREAU OF LAND MANAGEMENT, KERN COUNTY PARKS, KERN COUNTY PUBLIC WORKS, KEEP KERN BEAUTIFUL, SIERRA NEVADA ALLIANCE AND ROCKY MOUNTAIN RECREATION.

I understand and agree to assume the risks related to cleaning up beaches or inland water areas, including but not limited to, the risks of possible injury, infection, and loss of life as a result of contact with needles, condoms, metal objects, burning embers and other hazardous materials, wild animals, and poisonous plants; as well as the risks from overexertion and environmental conditions, including but not limited to wave activity, flooding, rockslides, sun exposure, and dangerous terrain.

I understand and agree to assume the risks related to the use of any watercraft, whether as an operator or passenger, including but not limited to risks related to marine facilities, fuels and lubricants, weather, tides and other water movement, operational proficiency, overexertion by myself or others on the craft, collisions, and conditions such as water temperature, including the risks associated with hypothermia, sun exposure, swimming proficiency, and rescue efforts.

In the circumstance of injury or illness, I authorize qualified emergency medical professionals to examine and administer emergency care to me, regardless of whether I am able to specifically agree to treatment at the time it is administered. I understand and agree to assume the risks related to medical treatment.

I HEREBY RELEASE AND HOLD HARMLESS THE RELEASED PARTIES FROM ANY CLAIM OR LAWSUIT FOR PERSONAL INJURY, PROPERTY DAMAGE, OR WRONGFUL DEATH, BY ME, MY FAMILY, ESTATE, HEIRS, OR ASSIGNS, ARISING OUT OF PARTICIPATION IN THE EVENT, INCLUDING CLAIMS ARISING DURING THE ACTIVITY AND AFTER I COMPLETE THE ACTIVITY, AND INCLUDING CLAIMS BASED ON NEGLIGENCE OF OTHER PARTICIPANTS OR THE RELEASED PARTIES.

I agree to allow my image to be used in published materials and websites that promote the programs of the KERN RIVER CONSERVANCY / SOUTHERN SIERRA CONSERVANCY or any programs conducted by the Released Parties.

Date Signed: April 30, 2024

Please select who will be participating...

Adult Minor(s)
1 Minor 2 Minors 3 Minors 4 Minors 5 Minors More Minors 6 Minors 7 Minors 8 Minors 9 Minors 10 Minors

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Second Participant's Name

First Name*

Last Name*

Second Participant's Date of Birth*

Second Participant's Information

Address *

City *

State *

Zip Code *

Ethnicity?

Gender?

Veteran?

Disabled?

Size of Group *

Unless I opt out here , I agree that the KERN RIVER CONSERVANCY may contact me about future events and other Public Education programs.

OPT OUT

HOW DID YOU HEAR ABOUT THE EVENT? (please mark all that apply)

Website

Social Media

Poster/Flyer

School/Work/Community Group

Friend

Radio/TV

Newspaper/Magazine

Which area are you registering for?*

Third Participant's Name

First Name*

Last Name*

Third Participant's Date of Birth*

Third Participant's Information

Address *

City *

State *

Zip Code *

Ethnicity?

Gender?

Veteran?

Disabled?

Size of Group *

Unless I opt out here , I agree that the KERN RIVER CONSERVANCY may contact me about future events and other Public Education programs.

OPT OUT

HOW DID YOU HEAR ABOUT THE EVENT? (please mark all that apply)

Website

Social Media

Poster/Flyer

School/Work/Community Group

Friend

Radio/TV

Newspaper/Magazine

Which area are you registering for?*

Fourth Participant's Name

First Name*

Last Name*

Fourth Participant's Date of Birth*

Fourth Participant's Information

Address *

City *

State *

Zip Code *

Ethnicity?

Gender?

Veteran?

Disabled?

Size of Group *

Unless I opt out here , I agree that the KERN RIVER CONSERVANCY may contact me about future events and other Public Education programs.

OPT OUT

HOW DID YOU HEAR ABOUT THE EVENT? (please mark all that apply)

Website

Social Media

Poster/Flyer

School/Work/Community Group

Friend

Radio/TV

Newspaper/Magazine

Which area are you registering for?*

Fifth Participant's Name

First Name*

Last Name*

Fifth Participant's Date of Birth*

Fifth Participant's Information

Address *

City *

State *

Zip Code *

Ethnicity?

Gender?

Veteran?

Disabled?

Size of Group *

Unless I opt out here , I agree that the KERN RIVER CONSERVANCY may contact me about future events and other Public Education programs.

OPT OUT

HOW DID YOU HEAR ABOUT THE EVENT? (please mark all that apply)

Website

Social Media

Poster/Flyer

School/Work/Community Group

Friend

Radio/TV

Newspaper/Magazine

Which area are you registering for?*

Sixth Participant's Name

First Name*

Last Name*

Sixth Participant's Date of Birth*

Sixth Participant's Information

Address *

City *

State *

Zip Code *

Ethnicity?

Gender?

Veteran?

Disabled?

Size of Group *

Unless I opt out here , I agree that the KERN RIVER CONSERVANCY may contact me about future events and other Public Education programs.

OPT OUT

HOW DID YOU HEAR ABOUT THE EVENT? (please mark all that apply)

Website

Social Media

Poster/Flyer

School/Work/Community Group

Friend

Radio/TV

Newspaper/Magazine

Which area are you registering for?*

Seventh Participant's Name

First Name*

Last Name*

Seventh Participant's Date of Birth*

Seventh Participant's Information

Address *

City *

State *

Zip Code *

Ethnicity?

Gender?

Veteran?

Disabled?

Size of Group *

Unless I opt out here , I agree that the KERN RIVER CONSERVANCY may contact me about future events and other Public Education programs.

OPT OUT

HOW DID YOU HEAR ABOUT THE EVENT? (please mark all that apply)

Website

Social Media

Poster/Flyer

School/Work/Community Group

Friend

Radio/TV

Newspaper/Magazine

Which area are you registering for?*

Eighth Participant's Name

First Name*

Last Name*

Eighth Participant's Date of Birth*

Eighth Participant's Information

Address *

City *

State *

Zip Code *

Ethnicity?

Gender?

Veteran?

Disabled?

Size of Group *

Unless I opt out here , I agree that the KERN RIVER CONSERVANCY may contact me about future events and other Public Education programs.

OPT OUT

HOW DID YOU HEAR ABOUT THE EVENT? (please mark all that apply)

Website

Social Media

Poster/Flyer

School/Work/Community Group

Friend

Radio/TV

Newspaper/Magazine

Which area are you registering for?*

Ninth Participant's Name

First Name*

Last Name*

Ninth Participant's Date of Birth*

Ninth Participant's Information

Address *

City *

State *

Zip Code *

Ethnicity?

Gender?

Veteran?

Disabled?

Size of Group *

Unless I opt out here , I agree that the KERN RIVER CONSERVANCY may contact me about future events and other Public Education programs.

OPT OUT

HOW DID YOU HEAR ABOUT THE EVENT? (please mark all that apply)

Website

Social Media

Poster/Flyer

School/Work/Community Group

Friend

Radio/TV

Newspaper/Magazine

Which area are you registering for?*

Tenth Participant's Name

First Name*

Last Name*

Tenth Participant's Date of Birth*

Tenth Participant's Information

Address *

City *

State *

Zip Code *

Ethnicity?

Gender?

Veteran?

Disabled?

Size of Group *

Unless I opt out here , I agree that the KERN RIVER CONSERVANCY may contact me about future events and other Public Education programs.

OPT OUT

HOW DID YOU HEAR ABOUT THE EVENT? (please mark all that apply)

Website

Social Media

Poster/Flyer

School/Work/Community Group

Friend

Radio/TV

Newspaper/Magazine

Which area are you registering for?*

Parent or Guardian's Email Address

Email*

Confirm Email*

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Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*

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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