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Volunteer Waiver

All VOLUNTEER participants—please read and agree below.

I understand that participating in Loudoun Wildlife Conservancy activities is entirely voluntary. I also understand that volunteer events may involve physical activity, including hiking, weeding, bending, lifting, digging, using heavy tools, etc., in all kinds of weather that expose me to risks and dangers that may result in injury or death. I know and understand the risks and dangers involved in the above-mentioned activities, and I know and understand that unanticipated dangers may arise.

I hereby assume all responsibility and risk, and agree to release and waive all claims, including claims against parties partnering with Loudoun Wildlife Conservancy, causes of action, judgments, and expenses, including reasonable attorney fees and costs, in connection with injuries or damage to persons or property sustained or incurred in connection with, or as a result of, my activities while volunteering with Loudoun Wildlife Conservancy, and hereby agree to indemnify and hold Loudoun Wildlife Conservancy, its staff, officers, directors, members, volunteers, and any others acting on behalf of Loudoun Wildlife Conservancy, and parties partnering with Loudoun Wildlife Conservancy, harmless in connection with any and all of the foregoing.

Participant agreement

I agree

Contact Information

Name

First Name

Last Name

Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Phone

Verify Email

Photo consent

Participant consents to the use by Loudoun Wildlife Conservancy of any photo of the participant or participant’s child taken during Loudoun Wildlife Conservancy activities.

Yes

If you are under 18, the name and agreement of parent or guardian is required.

I am the parent or legal guardian of the participant indicated above. I hereby give permission for my child to participate in this activity. I have read and understand the information included in this form and I agree to all provisions set forth herein.

Parent/guardian name

Emergency Contact Information

In case of an emergency, please contact:

Name and relationship

Phone number

Do you have any known allergies (food, medicine, latex, bees, etc.) that we should be aware of?

Please list any medications that you are taking that you want us to be aware of (in case of an emergency):

If you have a heart condition, high blood pressure, diabetes, or other medical condition that you want us to be aware of (in case of an emergency, please explain.

Date

(mm/dd/yyyy)