Merrill W. Linn Land & Waterways Conservancy · 2024-04-26 Tree Walk Program Series: Arbor Day Tree Walk in Downtown Lewisburg

Participant Information

Name (Or Parent/Guardian's name if registering a minor)

*

First Name

Last Name

Email (Or Parent/Guardian's email if registering a minor)

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Verify Email

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Phone Number (Or Parent/Guardian's phone number if registering a minor)

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Address (Or Parent/Guardian's address if registering a minor)

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Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Do you have any allergy/medical concerns that staff should be aware of?

Yes

No

Please list allergies, including food, and known reactions/medical concerns if applicable.

Additional Participants

# of Additional Participants

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Select the number of additional participants that you're registering for this event, including children under 18 years old.

Additional Participant Information #1

Name

*

First Name

Last Name

Is this participant a minor?

*

Yes

No

Participant's Birth Date (if a minor)

*

(mm/dd/yyyy)

Names and phone numbers of people (including parents) that have permission to drop-off and/or pick up minor.

*

Individuals may be asked to show ID before a child is released to their care.

Does the participant have any allergy/medical concerns that staff should be aware of?

Yes

No

Please list allergies, including food, and known reactions/medical concerns if applicable.

Additional Participant Information #2

Name

*

First Name

Last Name

Is this participant a minor?

*

Yes

No

Participant's Birth Date (if a minor)

*

(mm/dd/yyyy)

Names and phone numbers of people (including parents) that have permission to drop-off and/or pick up minor.

*

Individuals may be asked to show ID before a child is released to their care.

Does the participant have any allergy/medical concerns that staff should be aware of?

Yes

No

Please list allergies, including food, and known reactions/medical concerns if applicable.

Additional Participant Information #3

Name

*

First Name

Last Name

Is this participant a minor?

*

Yes

No

Participant's Birth Date (if a minor)

*

(mm/dd/yyyy)

Names and phone numbers of people (including parents) that have permission to drop-off and/or pick up minor.

*

Individuals may be asked to show ID before a child is released to their care.

Does the participant have any allergy/medical concerns that staff should be aware of?

Yes

No

Please list allergies, including food, and known reactions/medical concerns if applicable.

Additional Participant Information #4

Name

*

First Name

Last Name

Is this participant a minor?

*

Yes

No

Participant's Birth Date (if a minor)

*

(mm/dd/yyyy)

Names and phone numbers of people (including parents) that have permission to drop-off and/or pick up minor.

*

Individuals may be asked to show ID before a child is released to their care.

Does the participant have any allergy/medical concerns that staff should be aware of?

Yes

No

Please list allergies, including food, and known reactions/medical concerns if applicable.

Additional Participant Information #5

Name

*

First Name

Last Name

Is this participant a minor?

*

Yes

No

Participant's Birth Date (if a minor)

*

(mm/dd/yyyy)

Names and phone numbers of people (including parents) that have permission to drop-off and/or pick up minor.

*

Individuals may be asked to show ID before a child is released to their care.

Does the participant have any allergy/medical concerns that staff should be aware of?

Yes

No

Please list allergies, including food, and known reactions/medical concerns if applicable.

RELEASE OF LIABILITY - This is a contract so please read it!

Activity Organizer: Merrill W. Linn Land & Waterways Conservancy (“Conservancy”)

Activity Description: I understand that the terms of this form are unlimited in duration and cover all Activities that I participate in at any time in the future (“Activity”)

In consideration of being allowed to participate in the Activity, IF I OR THE PERSON FOR WHOM I AM SIGNING THIS CONTRACT IS INJURED participating in the Activity or while present on the Conservancy's property, I AGREE TO BE LEGALLY BOUND by the promises set forth below. I understand that the term “Conservancy” includes the Conservancy identified above, its members, officers, directors, agents, servants, and employees, volunteers, and, if not owned by the Conservancy, the owners of the land on which the Activity is taking place (that land, the “Property”):

I WILL NOT SUE the Conservancy.
FOREVER RELEASE the Conservancy from any and all liability for the injury.
I WILL INDEMNIFY AND HOLD HARMLESS the Conservancy from any loss, liability, damage, or cost of any kind that may occur as a result of the injury.
I AGREE THAT THE ABOVE PROMISES ARE LEGALLY BINDING even if I contend that my injuries are wholly or partly the result of NEGLIGENCE or other CONDUCT on the part of Conservancy for which a release is not contrary to public policy.
I voluntarily ASSUME THE RISK OF INJURY OR EVEN DEATH while participating in the Activity or entering the Property. If I am injured, I authorize Conservancy to provide EMERGENCY FIRST AID and any medical or first aid personnel to provide MEDICAL CARE until such time as I or someone authorized by my medical care power of attorney or otherwise by law is able to act on my behalf.
I understand that the Activity may be INHERENTLY DANGEROUS.
I recognize my responsibility to INSPECT trails and other facilities within the Property, to exercise GOOD JUDGMENT, to ACT RESPONSIBLY, and to OBEY all of Conservancy's oral or written guidance, instructions (including signage), and warnings.
I AGREE that the promises set forth above also apply to any LOSS OF OR DAMAGE to any of my belongings for which Conservancy may be legally liable in connection with the Activity including any transportation or storage.
I release to Conservancy and authorize Conservancy to produce, reproduce, broadcast, and otherwise use PHOTOS, VIDEOS, and other depictions, likenesses, or images of me, in any media form in connection with my attendance at or participation in the Activity, without compensation, for an unlimited duration.
I agree that the only court to decide any matter covered by this contract are the Court of Common Pleas of Union County, Pennsylvania. This agreement shall be governed by Pennsylvania law.

I am 18 YEARS OF AGE OR MORE or I am AGREEING AS PARENT OR GUARDIAN of a minor child with the consent of the other parent or guardian (if any). I understand that I may be giving up the rights of my child and spouse to sue as well as giving up my own right to sue. I have read and understood these promises, am VOLUNTARILY agreeing to them, and am INTENDING TO BE LEGALLY BOUND.

Release of Liability Waiver

*

All participants must agree (or by a parent/guardian if a minor) to our Release of Liability before being allowed to participate in any and all activities.

I certify that I have read and agree to the Linn Conservancy's Release of Liability Waiver and that I am 18 YEARS OF AGE OR MORE or I am AGREEING AS PARENT OR GUARDIAN of a minor child with the consent of the other parent or guardian (if any).

Payment

Program Fee - Pay What You Can! ($5 per person suggested donation to help cover costs)

$