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Piedmont Wildlife Center

364 Leigh Farm Road

Durham, NC 27707

919-489-0900 

admin@piedmontwildlifecenter.org


CONSERVATION LIABILITY WAIVER

In consideration of registration for the program(s) for myself or as legal guardian of said minor(s), I, intending to be legally bound, hereby for myself and heirs, executors and administrators, waive and release any and all rights and claims for damages I may have against Piedmont Wildlife Center, their representatives, successors, assigns and host landowners, for accident or injury incurred by myself or said minor during or because of this event. The Releasor releases and forever discharges the Releasee, their directors, officers, employees, agents, assigns and successors from all manner of actions, causes of action, debts, accounts, claims and demands for or by any damage, loss or injury to person and property which may be sustained while attending said event, as parent or legal guardian, do hereby grant PWC staff the right to authorize emergency medical treatment for the participant named above in the event that I, or my designated representative, cannot be reached. I agree to hold harmless Piedmont Wildlife Center, and its agents from liability arising out of an accident. The NC Good Samaritan Law will apply. This agreement will be construed in accordance with and governed by the laws of the State of North Carolina. It is declared that the terms of this Release of claim are fully understood.

I understand and acknowledge that naturally occurring disease processes (including, but not limited to, the novel coronavirus (“COVID-19”) can occur in all environments in which PIEDMONT WILDLIFE CENTER’s activities take place, and that COVID-19 infections have been confirmed throughout the state of North Carolina. I acknowledge that, while PWC has taken reasonable measures to avoid contact, transmittal, and exposure of the virus or other communicable disease between people (including between campers, program participants, employees, volunteers and third parties), it is ultimately my sole responsibility to ensure that I take appropriate actions, as outlined by the Centers for Disease Control (“CDC”), to safe-guard myself and/or my child and others by following the protocols set forth by PIEDMONT WILDLIFE CENTER. I understand and agree that PIEDMONT WILDLIFE CENTER follows recommendations by the CDC, the North Carolina Department of Health and Human Services (“NCDHHS”), and pertinent County Health Departments. Click here for PWC’s protocols. I agree that I have read the protocols provided through the link and I understand them. I understand and agree that they may be revised at any time based on updated recommended guidance and protocols issued by the CDC and NCDHHS, and County Health Departments, and that PWC will notify me of any changes that would affect programs I and/or my child is to participate in. By agreeing for myself and/or my child to participate in PWC programs, I am accepting and assuming the risk that I and/or my child may be exposed to and become ill as a result of COVID-19 and other communicable diseases. This is an inherent risk of participating in any PWC programs at any location.

In addition to the release of claims, I agree to PWC’s protocols and expectations for myself and/or my child to attend PIEDMONT WILDLIFE CENTER programs. I, on behalf of myself, my child and our respective heirs, successors, and assigns hereby voluntarily release, forever discharge, and covenant not to sue PIEDMONT WILDLIFE CENTER, THE CITY OF DURHAM, ORANGE or WAKE COUNTIES, NORTH CAROLINA, THE STATE OF NORTH CAROLINA, or any other locations where PWC programs operate and, if any, its owners, managers, members, employees, representatives, agents, and volunteers (‘Released Parties’) for any claims that may arise out of, or relate in any way to my or my child’s exposure to a communicable disease, including, but not limited to, COVID-19. The claims hereby released include, but are not limited to, claims of negligence against any of the released parties.

IMAGE POLICY

Piedmont Wildlife Center may use images for promotional purposes. If you do not want yours 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.

AGE POLICY

Participants must be the required age for each program by the date that the program begins. If a participant is registered for a program and they are the wrong age, they will be withdrawn from the program and provided a refund minus a $25 administrative fee. In rare cases, an age exception may be offered. However, this must be requested prior to registering and paying for a program. Age exceptions are considered on a case by case basis. Contact us at admin@piedmontwildlifecenter.org to request an age exemption and make sure to include why the age exemption is appropriate.

I HAVE CAREFULLY READ THIS AGREEMENT AND VOLUNTARILY SIGN this assumption of risk, release, and waiver of liability, and indemnity agreement and further agree that no oral representations, statements, or inducement apart from the foregoing written agreement have been made. By signing below, I UNDERSTAND THAT I HAVE GIVEN UP CERTAIN LEGAL RIGHTS, including the right to recover damages from Piedmont Wildlife Center in case of illness or death, including for the avoidance of doubt and without limitation, exposure to COVID-19 at any PWC program or place of operation and any illness, injury, or death resulting therefrom. I UNDERSTAND THAT THIS DOCUMENT IS A PROMISE NOT TO SUE AND A RELEASE OF AND INDEMNIFICATION FOR ALL CLAIMS. I FULLY UNDERSTAND THIS CONTENT AND THAT THIS IS A BINDING LEGAL DOCUMENT.



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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