NCF · 2024 Needham Community Farm Waiver Form

This Waiver is for: *

Adult or Family - can include children coming to farm WITH parent/guardian

Youth/Minor (under age 18) - coming to farm WITHOUT parent/guardian

Youth/Minor Waiver

This section is for a Youth/Minor (under age 18) who will be coming to the farm with a group or as an individual volunteer. If the Youth/Minor will be coming to the farm with their family, please go back and selection "Adult or Family" option.

Name of Youth/Minor *

First Name

Last Name

Email of Youth/Minor (optional)

Verify Email

Address of Youth/Minor *

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Phone Number of Youth/Minor (Optional)

Please enter in formation XXX-YYY-ZZZZ

Join the Needham Community Farm Email list (youth/minor)? *

I would like to subscribe to the Needham Community Farm email list, for monthly Newsletters and other notifications.

Yes - Add Youth/Minor to the List!

Yes - Youth/Minor is already on the List, keep them on!

No - Do not add to the List

Age of Youth/Minor *

Under 10 years old

11 to 13 years old

14 to 17 years old

Is the Minor/Youth coming to the Farm for CSL (Community Service Learning) hours? *

Yes

No

Is the Minor/Youth coming to the farm with a school, camp, or other volunteer group? *

Yes

No

Name of School *

Please fill in the name of the CSL School - for example: Needham High School, Pollard Middle School, Nobles & Greenough, etc...

Name of Volunteer Group, School, or Camp *

Examples: Needham High School, Needham Steps Up, Nobles, Rivers School, etc...

Name of Volunteer Group, School, or Camp: *

Examples: Needham High, Needham Steps Up, Nobles, Rivers School, etc...

Year of High School Graduation *

Parent/Guardian Information

Adult Information

Adult or Family Waiver

Each Adult planning to come to the Farm must fill out a waiver for themselves. Minor (under 18) family members should be included on one or both adult family member's forms. For Youth/Minor family members who will be coming to the farm without a parent or guardian (i.e. with a group or as a CSL volunteer) please go back to the top and choose "Youth/Minor".

Adult Name *

First Name

Last Name

Adult Email *

Verify Email *

Parent/Guardian Phone Number *

Would Parent/Guardian like to receive Needham Community Farm monthly Newsletter and other information? *

Yes, add me to the Email List!

Yes, I'm already on the List, keep me on!

No, I do not wish to receive emails.

Emergency Contact Information

Name of Emergency Contact - Parent/Guardian Name may be entered here, or add alternate name if Parent/Guardian is NOT Emergency Contact *

Name (First and Last)

Relationship to Participant? *

Phone Number of Emergency Contact *

Youth/Minor Covid-19 Protocols, Photo Release, and Electronic Signature

Covid-19 Protocols at NCF for Youth/Minor

Masks are not required at NCF, but you are welcome to wear one if you prefer. Please respect those who choose to wear one. Covid-19 protocols may change at any time. If the protocols are modified, you will receive a copy of modifications directly and they will be posted at the farm.

I agree that youth/minor will not come to the Farm if they are sick or showing symptoms of any form of transmissible disease. *

I agree

I do not agree

If youth/minor tests positive for Covid-19, or has a close exposure to someone who is positive, they will not come to the farm until waiting at least 5 days after the positive test or exposure, and test negative. *

I agree

I do not agree

I agree to notify the Needham Community Farm if youth/minor tests positive for COVID-19 within 5 days after volunteering on the farm. *

I agree

I do not agree

Youth/Minor Picture Release *

Needham Community Farm occasionally uses pictures and videos of volunteers and program participants on the Farm website and in printed material, videos, social media, and picture displays. Please read the following and choose an option.

I hereby grant Needham Community Farm the right and permission to use pictures/videos in which the above named Minor/Youth may be included in conjunction with Needham Community Farm activities in photographs, videos, online, and printed material.

I hereby state that I do NOT grant permission to use pictures/videos of the above named Minor/Youth as stated above.

By entering your name and today's date below, you are submitting an electronic signature for this consent form, release from indemnity, and the option you have selected above for the photo and video release. This is the "Youth/Minor" Waiver. If the Participant/Volunteer is age 18 or above, please fill go back to the top and choose "Adult or Family".

If Consent Form and Signature Fields do NOT appear below, you MUST go back and AGREE to all Covid-19 Protocol questions.

CONSENT FORM, RELEASE FROM LIABILITY & INDEMNITY AGREEMENT

I realize injuries can occur from participation in Farm programs. I hereby waive, release, absolve, indemnify and agree to hold harmless Needham Community Farm (“NCF”), including its contracted teachers, and the Town of Needham and its departments, officers, employees, and agents (collectively, "Needham") from any and all claims, damages, losses or expenses of whatever kind or nature which the above named Minor/Youth may have or acquire arising out of or resulting, directly or indirectly, from participation in NCF programs. I also RELEASE and discharge Needham from any and all claims, damages, losses or expenses of whatever kind or nature which the above named Minor/Youth may have or acquire arising out of or resulting from, directly or indirectly participation in NCF programs. I furthermore agree to defend and INDEMNIFY NCF and/or Needham against any claim, damage, loss or expense of whatever kind or nature that Needham may have to pay that arises from the intentional, grossly negligent, or reckless acts or omissions of the above named Minor/Youth while participating in NCF programs.

Parent/Guardian Electronic Signature *

Parent/Guardian Date of Signing *

(mm/dd/yyyy)

Spouse or Partner Name

Note that all adults coming to the Farm will need to fill out their own Waiver.

Names of Minor Family Members who will be coming to the Farm (and covered by this Waiver)

Please include first and last names of each minor child, separated by commas.

Adult or Family Address *

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Adult's Phone *

Join the Needham Community Farm Email List? *

I would like to subscribe to the Needham Community Farm email list, for monthly Newsletter and other notifications.

Yes - Add me to the List!

Yes - I'm already on the List, keep me on!

No - Do not add me to the List

Please choose the primary reason you are visiting the Farm: *

Volunteering as Individual

Volunteering with a Group

Attending a Class, Tour, or Other Program

Volunteer Group Name *

Please enter "Self" if you are not coming with a group.

Emergency Contact Information

Name of Emergency Contact *

Name (First and Last)

Relationship to Adult? *

Phone Number of Emergency Contact *

Adult or Family Covid-19 Protocols, Photo Release, and Electronic Signature

Covid-19 Protocols at NCF

Masks are not required at NCF, but you are welcome to wear one if you prefer. Please respect those who choose to wear one. Covid-19 protocols may change at any time. If the protocols are modified, you will receive a copy of modifications directly and they will be posted at the farm.

I agree that I will not come to the Farm if I am sick or showing symptoms of any form of transmissible disease. *

I agree

I do not agree

If I test positive for Covid-19, or have a close exposure to someone who is positive, I will not come to the farm until waiting at least 5 days after the positive test or exposure, and test negative. *

I agree

I do not agree

I agree to notify the Needham Community Farm if I test positive for COVID-19 within 5 days after volunteering on the farm. *

I agree

I do not agree

Family Picture Release *

Needham Community Farm occasionally uses pictures and videos of volunteers and program participants on the Farm website and in printed material, videos, social media, and picture displays. Please read the following and choose an option.

I hereby grant Needham Community Farm the right and permission to use pictures/videos in which the above named Family Members may be included, in conjunction with Needham Community Farm activities in photographs, videos, online, and printed material.

I hereby state that I do NOT grant permission to use pictures/videos of the above named Family Members as stated above.

By entering your name and today's date below, you are submitting an electronic signature for this consent form, release from indemnity, and the option you have selected above for the photo and video release. This is the "Adult or Family Waiver. If the Participant/Volunteer is age 18 or above, please go back to the top and choose "Youth/Minor"

If Consent Form and Signature Fields do NOT appear below, you MUST go back and AGREE to all Covid-19 Protocol questions.

CONSENT FORM, RELEASE FROM LIABILITY & INDEMNITY AGREEMENT

I realize injuries can occur from participation in Farm programs. I hereby waive, release, absolve, indemnify and agree to hold harmless Needham Community Farm (“NCF”), including its contracted teachers, and the Town of Needham and its departments, officers, employees, and agents (collectively, "Needham") from any and all claims, damages, losses or expenses of whatever kind or nature which I or the above named Family Member(s) may have or acquire arising out of or resulting, directly or indirectly, from participation in NCF programs. I also RELEASE and discharge Needham from any and all claims, damages, losses or expenses of whatever kind or nature which I or the above named Family Member(s) may have or acquire arising out of or resulting from, directly or indirectly participation in NCF programs. I furthermore agree to defend and INDEMNIFY NCF and/or Needham against any claim, damage, loss or expense of whatever kind or nature that Needham may have to pay that arises from the intentional, grossly negligent, or reckless acts or omissions of myself or the above named Family Member(s) while participating in NCF programs.

Adult Electronic Signature *

Adult Date of Signing *

(mm/dd/yyyy)

2024 Needham Community Farm Waiver Form

Thank you for planning a visit to the Needham Community Farm! Please choose the appropriate Waiver below.

Each Adult volunteer or visitor must fill out a Waiver.

For youth/minor family member coming to the farm WITH parent/guardian, please choose Adult/Family below, and include their names on one or both parent/guardian waivers.

For Youth/Minor (age 17 or under) family member coming to the farm WITHOUT parent/guardian, please (choose Youth/Minor below).

Youth/Minor Waiver

Parent/Guardian Information

Adult Information

Adult or Family Waiver

Emergency Contact Information

Youth/Minor Covid-19 Protocols, Photo Release, and Electronic Signature

Covid-19 Protocols at NCF for Youth/Minor

If Consent Form and Signature Fields do NOT appear below, you MUST go back and AGREE to all Covid-19 Protocol questions.

Emergency Contact Information

Adult or Family Covid-19 Protocols, Photo Release, and Electronic Signature

Covid-19 Protocols at NCF

If Consent Form and Signature Fields do NOT appear below, you MUST go back and AGREE to all Covid-19 Protocol questions.