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In consideration of the acceptance of my participation or the participation of my child or ward, at Sanibel-Captiva Conservation Foundation, Inc. dba Sanibel Sea School, I, the undersigned, for myself, my child or ward, and our heirs, legal and personal representatives, executors, administrators, successors and assigns, agree to the following terms and conditions.

I ACKNOWLEDGE that participation in Sanibel-Captiva Conservation Foundation, Inc. dba Sanibel Sea School programs and activities exposes myself, or my child or ward, to danger and health/safety risks, such as (1) the natural beach, barrier island, and ocean environment, including live sea creatures which may bite, sting or cause an allergic reaction, among other things; (2) wading, snorkeling, and surfing; (3) plant life, which may cause allergic reactions; (4) the sun and heat, which may cause burns, dehydration, and stroke; (5) environmental hazards, such as debris, seashells, seaweed and trash; and (6) arts and crafts materials, including, but not limited to, paint, glue, glue guns, markers, crayons, paper, felt and scissors.

I ACKNOWLEDGE that I, or my child or ward, will be transported in motorized vehicles and watercraft to the beach, barrier islands, and ocean. I acknowledge the inherent danger involved in these types of transportation.

I AFFIRM that I, and my child or ward, are not currently ill or experiencing any symptoms of COVID-19 or any other communicable illness.

I AGREE that if I think or know I, or my child or ward, were affected with COVID-19 or any other communicable illness, then I, or my child or ward, will not participate in Sanibel-Captiva Conservation Foundation, Inc. dba Sanibel Sea School programs until I or my child or ward have been deemed non- contagious and any remaining symptoms have improved.

Sanibel-Captiva Conservation Foundation, Inc., dba Sanibel Sea School tries to ensure the program environment is free from common allergenic substances. Despite attempts otherwise, persons prone to adverse severe allergic reactions from certain foods, materials, or natural substances may be inadvertently exposed to such allergens while participating in Sanibel-Captiva Conservation Foundation, Inc. dba Sanibel Sea School programs. I ACKNOWLEDGE the possible allergic risk described above and agree to participate, or allow my child or ward, to participate in the program knowing such exposure may occur.

I KNOWINGLY AND WILLINGLY AGREE TO ASSUME THE RISKS inherent and incidental to participation in Sanibel-Captiva Conservation Foundation, Inc. dba Sanibel Sea School programs and activities, including, but not limited to, those risks set out above, on my behalf or on behalf of my child or ward.

I AGREE TO RELEASE and forever discharge the Released Parties defined below from all liabilities, claims, actions, damages, costs, or expenses of any nature arising out of or in any way connected with my participation, or the participation of my child or ward, in Sanibel-Captiva Conservation Foundation, Inc. dba Sanibel Sea School. I FURTHER AGREE TO INDEMNIFY AND HOLD HARMLESS each of the Released Parties against any and all liabilities, claims, actions, damages, costs, or expenses, including, but not limited to, attorney's fees and disbursements.

The released parties are the SANIBEL-CAPTIVA CONSERVATION FOUNDATION, INC. DBA SANIBEL SEA SCHOOL and its CORPORATE PARTNERS, their parent, related affiliated and subsidiary companies, and the officers, directors, employees, agents, representatives, volunteers, successors and assigns of each. I understand that this RELEASE AND INDEMNITY includes any claims based on the negligence, actions, or inaction of any of the above Released Parties and covers bodily injury and property damage, whether suffered by me, my child, or my ward before, during, or after such participation.

I FURTHER AUTHORIZE any of the Released Parties defined above to provide or seek medical care and treatment and emergency medical services associated with my activities, or those of my child's or my ward's, as a result of participation in Sanibel-Captiva Conservation Foundation, Inc. dba Sanibel Sea School programs. I agree to be liable for any costs, expenses, or bills associated with such care and treatment. I fully agree to reimburse, release, indemnify and hold harmless the above Released Parties for such amounts.

I ACKNOWLEDGE that while participating in Sanibel Sea School Inc. programs and activities, its employees, volunteers, and agents may, from time to time, take photographs of participants for use in its promotional advertising. I AUTHORIZE Sanibel-Captiva Conservation Foundation, Inc. dba Sanibel Sea School to utilize my likeness, or the likeness of my child or my ward, in these promotional advertisements.

I have read this ACKNOWLEDGEMENT, ASSUMPTION OF RISK, RELEASE OF LIABILITY AND INDEMNITY, AND AUTHORIZATION AGREEMENT in its entirety and understand all of its terms, its contents, and the ramifications of the AGREEMENT. I am aware that I am releasing certain legal rights and have executed this AGREEMENT voluntarily. 

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Medical Information

Please list medications (prescriptions, epi-pens, inhalers, etc.)

Please list allergies (food, medication, other)

Please list any other relevant medical or behavioral conditions.

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First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Medical Information

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Please list allergies (food, medication, other)

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Anything else you'd like to share with us?
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Medical Information

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Anything else you'd like to share with us?
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Medical Information

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Anything else you'd like to share with us?
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Medical Information

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Please list allergies (food, medication, other)

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Anything else you'd like to share with us?
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Medical Information

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Please list any other relevant medical or behavioral conditions.

Anything else you'd like to share with us?
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Medical Information

Please list medications (prescriptions, epi-pens, inhalers, etc.)

Please list allergies (food, medication, other)

Please list any other relevant medical or behavioral conditions.

Anything else you'd like to share with us?
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Medical Information

Please list medications (prescriptions, epi-pens, inhalers, etc.)

Please list allergies (food, medication, other)

Please list any other relevant medical or behavioral conditions.

Anything else you'd like to share with us?
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Medical Information

Please list medications (prescriptions, epi-pens, inhalers, etc.)

Please list allergies (food, medication, other)

Please list any other relevant medical or behavioral conditions.

Anything else you'd like to share with us?
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Medical Information

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Please list any other relevant medical or behavioral conditions.

Anything else you'd like to share with us?
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information and program updates from Sanibel Sea School by e-mail.
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:*
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*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Medical Information

Please list medications (prescriptions, epi-pens, inhalers, etc.)

Please list allergies (food, medication, other)

Please list any other relevant medical or behavioral conditions.

Anything else you'd like to share with us?
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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