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Piedmont Wildlife Center

364 Leigh Farm Road

Durham, NC 27707

919-489-0900 

admin@piedmontwildlifecenter.org


Liability Release and Photo Release for Adults

Personal Injury and Hazard Release Detail

In consideration for being allowed to participate, I willingly assume all risks associated with my or my child’s participation and I grant this release of liability. I or my child will listen carefully to the hazards outlined by the leader. I understand that my or my child’s participation in these events entails a risk of physical injury and that I or my child may be exposed to hazards including, by way of illustration but not limitation: exposure to extreme or inclement weather; passage on or through bodies of water; unmarked and unprotected topographic hazards such as cliffs, ravines, caves or falling rocks; exposure to poisonous plants, stinging insects, ticks and venomous snakes and arthropods; risks associated with operation of trail building tools and equipment; risks associated with strenuous activity; and risks associated with road hazards, including but not limited to, moving vehicles. I further understand that accidents or injuries may occur in locations or under circumstances where medical attention is not readily available. I expressly assume all risks associated with or arising from my or my child’s participation in these activities.  

I understand and agree that I or my child will abide by all instructions, rules and regulations of the leader designated by the Piedmont Wildlife Center regarding safety and the use of all equipment. I  understand that no drugs or alcoholic beverages of any type are allowed, and I or my child will be asked to leave if I or anyone in my party is suspected of being under the influence of drugs or alcohol (if program fee was required, this fee will not be refunded).

On behalf of myself, my estate and personal representative thereof, my heirs and assigns, I agree to  waive any liability arising out of any actual, alleged, or threatened infectious, pathogenic, toxic, or other harmful properties of any “organic pathogen”, which includes but may not be limited to bacteria, viruses or other pathogens whether or not a microorganism, regardless of whether such “organic pathogen” is the result of a local outbreak, epidemic, pandemic or unknown cause. I hereby forever release the Piedmont Wildlife Center, its officers, directors, employees and agents from any and all future costs, claims, losses, liabilities or damages arising from or in any way related to my participation on this outing. I intend this release to be effective, regardless whether the claim of liability is asserted in negligence, strict liability in tort, or other theory of recovery. For myself, my estate, and the personal representative thereof, my heirs and assigns, I covenant and agree to make no claim, not to institute any suit, action or proceeding against the Piedmont Wildlife Center, its officers, directors, employees and agents, relating to any accident, incident or occurrence arising out of or in connection with my or my child’s participation on this outing. 

Image & Photo Release Details

I understand that this event may be documented for the purposes of educating the public about PWC’s work. I hereby grant permission for Piedmont Wildlife Center to use photographs or video of me or my child on this activity in publications, websites and other publicity material. The image(s) will remain the property of  PWC and will be used for the designated purpose of promoting PWC’s mission.  

If you do not want your or your child’s  image to be used for marketing or promotion purposes, please provide written notice prior to program dates via email to admin@piedmontwildlifecenter.org.

PARTICIPANT APPROVAL:  I hereby release and agree to indemnify Piedmont Wildlife Center and those acting pursuant to their authority, from and against any liability arising out of the exercise of the rights granted herein. 



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 Signature*
Second Participant's Name

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email
Check to receive information, news, and discounts by e-mail from Piedmont Wildlife Center.
Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
Your Piedmont Wildlife Center Program
Please select the type of program you are attending at PWC.*
Field Trip (with school or large group)
Tour/Turtle Trek/Paws on the Porch
Birthday Party
Volunteering (group volunteering)

Date of your program *
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 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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