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My Nature Lab Educational Program Release and Waiver of Liability

In consideration for being permitted in My Nature Lab, be advised: WE ARE A HANDS ON LEARNING ENVIRONMENT. ATTENDEES MAY HOLD LIVE REPTILES AND AMPHIBIANS.

MUST BE LEGAL GUARDIAN - I understand that I cannot sign for anyone for whom I am not a legal guardian. If I choose to forge another parent or adult signature, I may be held financially responsible for any medical or legal costs incurred.

ASSUMPTION OF RISK - I agree that my child is voluntarily participating in the activities offered by My Nature Lab, including but not limited to activities that occur at the facility or during an off-site field advenure. The activities may include walking, running, wading through tall grass and in shallow water, and handling non-venomous reptiles and amphibians. These activities include inherent risks and injury can occur. On rare occasions these injuries can be serious. I accept and assume all of these inherent risks, my child's participation is completely voluntary, and I have elected to allow my child to participate with full awareness of the risks.

RELEASE OF LIABILITY - In consideration of my child being permitted to participate in activities offered at My Nature Lab, I hereby release, waive, discharge and indemnify My Nature Lab and its staff from any and all loss, liability, damage, or cost resulting from injury to my child or his or her property while my child is engaged in any of the activities offered by My Nature Lab.

PHOTOGRAPHY - Any photography, video, or audio taken by My Nature Lab staff at or during My Nature Lab activities will be owned by My Nature Lab and may be used for promotional use without compensation to the Participants.

BROAD SCOPE - This Registration, Release and Acknowledgement of Risk is intended to be as broad and inclusive as permitted by the laws of the State of Colorado, and if any portion hereof is held invalid, the balance shall, notwithstanding, continue in full legal force and effect.

First Participant's Name
First Name*
Last Name*
Phone*
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
First Participant's Medical Information

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Does the participant suffer from any allergies, illness, disabilities, or other medical conditions? If so, please describe.

Is there anything else you would like us to know about your child?
First Participant's Signature*
Second Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Second Participant's Medical Information

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Does the participant suffer from any allergies, illness, disabilities, or other medical conditions? If so, please describe.

Is there anything else you would like us to know about your child?
Third Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Third Participant's Medical Information

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Does the participant suffer from any allergies, illness, disabilities, or other medical conditions? If so, please describe.

Is there anything else you would like us to know about your child?
Fourth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Fourth Participant's Medical Information

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Does the participant suffer from any allergies, illness, disabilities, or other medical conditions? If so, please describe.

Is there anything else you would like us to know about your child?
Fifth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Fifth Participant's Medical Information

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Does the participant suffer from any allergies, illness, disabilities, or other medical conditions? If so, please describe.

Is there anything else you would like us to know about your child?
Sixth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Sixth Participant's Medical Information

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Does the participant suffer from any allergies, illness, disabilities, or other medical conditions? If so, please describe.

Is there anything else you would like us to know about your child?
Seventh Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Seventh Participant's Medical Information

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Does the participant suffer from any allergies, illness, disabilities, or other medical conditions? If so, please describe.

Is there anything else you would like us to know about your child?
Eighth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Eighth Participant's Medical Information

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Does the participant suffer from any allergies, illness, disabilities, or other medical conditions? If so, please describe.

Is there anything else you would like us to know about your child?
Ninth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Ninth Participant's Medical Information

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Does the participant suffer from any allergies, illness, disabilities, or other medical conditions? If so, please describe.

Is there anything else you would like us to know about your child?
Tenth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Tenth Participant's Medical Information

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Does the participant suffer from any allergies, illness, disabilities, or other medical conditions? If so, please describe.

Is there anything else you would like us to know about your child?
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address
Email*
Confirm Email*
Emergency Contact
First Name*
Last Name*
Emergency Contact's Phone Number*
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 Age Acknowledgment*
Parent or Guardian's Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
Parent or Guardian's Medical Information

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Does the participant suffer from any allergies, illness, disabilities, or other medical conditions? If so, please describe.

Is there anything else you would like us to know about your child?
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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