Mahoosuc Land Trust · June 1 Whitecap Workday Registration and Waiver

Participant or Volunteer Name *

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Last Name

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Verify Email *

In case of emergency, please contact: *

First Name

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Emergency Contact Phone *

Liability Waiver Agreement *

I have read and understand the liability waiver (linked above), and accept the terms & conditions.

Photographic Release *

The Participant does hereby grant and convey unto the Mahoosuc Land Trust all rights in any photographic images and video or audio recordings made by the Mahoosuc Land Trust during the Participant’s Activities with the Mahoosuc Land Trust.

I agree to this Photographic Release

I do *not* agree to this Photographic Release

Participant is a minor

Participant is under 18 years of age

IF PARTICIPANT IS UNDER 18 YEARS:

It is the policy of the Mahoosuc Land Trust that ultra-hazardous activity such as using power tools is not permitted by anyone under the age of 18. Further, the Mahoosuc Land Trust will not provide transportation for anyone under the age of 18. Minors under the age of 16 may only participate if accompanied by a parent or guardian.

PARENTAL AUTHORIZATION FOR SUPERVISION AND TREATMENT OF A MINOR CHILD

I am the parent or legal guardian having custody of the participant, a minor child. As such parent or legal guardian, I hereby authorize and
appoint myself or, in my absence the Participant's chaperone named below, an adult in whose care the minor child has been entrusted, as my agent to act for me with respect to my minor child and in my name in any way I could act in person to make any and all decisions for me with respect to my minor child, concerning my minor child’s supervision, personal care, medical treatment, hospitalization, and health care and to require, withhold or withdraw any type of medical treatment or procedure which may be rendered to my minor child under the supervision and on the advice of any physician licensed to practice in the state in which treatment is sought.

By clicking "Submit" below, I, as parent or guardian of the Participant named above, give my permission for the Participant to participate in these Activities, and also agree, on behalf of myself and the Participant, to all the terms of this Release.

Name of Chaperone for minor participant, if any:

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Please provide address information if you would like to receive occasional news from MLT

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June 1 Whitecap Workday Registration and Waiver

Click here to read the complete liability waiver