INCLUDES RELEASE OF MEDICAL, LIABILITY AND PHOTO/AUDIO-VISUAL CLAIMS. PLEASE READ ALL SECTIONS.
Thank you for participating in our activity or offering your time and services as a volunteer with the Yellow Dog Watershed Preserve (YDWP). Completing this release form is a requirement for going into the field with YDWP. It must be signed by the participant or volunteer prior to entering the field for any YDWP fieldwork. If you have any questions regarding the policies outlined in this form, please contact Mindy Otto, Executive Director, (906) 345-9223 or email@example.com. Thanks!
I acknowledge that I will be entering the field with Yellow Dog Watershed Preserve. I understand there are many possible hazards in YDWP fieldwork and travel into the field. I will be involved in activities that can be physically and mentally challenging, and involve an element of risk. Whereas YDWP staff will do everything possible to ensure a safe experience, there remains the possibility of injury to myself and others.
I understand YDWP is responsible for providing a safe and professional experience. However, I also realize the need for me to be accountable for my own safety and well-being. I agree to follow all staff instructions and directions, as they relate to conduct and safety, and to maintain the awareness of the need for safety at all times. In acknowledgement of the importance of being fully responsible for my current state of health and well-being, I will read the following sections, indicating that I have read and understood them by signing my name at the end of this document.
CONFIDENTIAL MEDICAL HISTORY
Before participating or volunteering with YDWP, it is important for the YDWP staff to be informed of any relevant medical conditions of the participant. A relevant medical condition or illness is one that, if for whatever reason were not attended to, could constitute a medical emergency, e.g., severe allergies, diabetes, severe migraines, etc. Most YDWP fieldwork is done in remote locations that are difficult to access and where medical assistance is not readily available. I acknowledge that I must disclose to YDWP staff all relevant medical conditions and physical activity concerns that may limit my participation. If I have any medical condition or problem that YDWP staff should be aware of, I understand it is my responsibility to inform YDWP of the existing condition in the following form, YDWP Medical History. I also understand the information I provide will be held in confidence and used only to render proper assistance should the need arise.
ASSUMPTION OF RISK
The physical and emotional well-being of all participants is a top priority of YDWP staff. While in the field, participants may be exposed to a variety of dangers. These dangers include but are not limited to traversing steep inclines, traveling over slippery and uneven surfaces, fording small streams, encountering bears and other wild animals, being bitten and stung by insect, becoming lost or stranded, facing inclement weather, and hiking through areas of thick underbrush and fallen trees. I realize that YDWP staff will inform me of a planned itinerary before any work in the backcountry, and will inform me of foreseeable hazards and the level of backcountry skill and experience that will be required to safely participate. Additionally, YDWP staff will take extreme caution in planning and leading a trip into the backcountry to ensure it is as safe as possible. However, I recognize that any backcountry travel involves the potential for unavoidable hazards. With these hazards in mind, I am willingly offering my time and expertise as a volunteer and do so after careful consideration of my own physical health, abilities and mental condition.
AUTHORIZATION OF MEDICAL CARE
In the event that I require medical attention while participating or volunteering with YDWP, I hereby grant permission to YDWP staff and its representative to render first aid and to seek emergency medical and rescue services for me. I hereby acknowledge that no guarantees have been made to me as to the effect of such procedures or treatment. I acknowledge that I am responsible for all expenses in connection with care and treatment rendered during this period.
I have adequate insurance to cover any injury or damage I may cause or suffer while participating or volunteering with YDWP. To the extent insurance is not available; I agree to bear the costs of such injury or damage to myself. I agree to assume the risk of any medical or physical condition that I may have.
WAIVER OF LEGAL CLAIMS
I, the undersigned, hereby acknowledge that I have been advised and fully understand that certain elements of danger are inherent in participating or volunteering with YDWP. The dangers are beyond the control of YDWP staff and that participation may entail unavoidable risk of personal injury, death and loss of or damage to property.
I hereby assume all risks of injury and death to myself and loss of or damage to property arising out of my participation. I agree to indemnify, waive, release, hold harmless and forever discharge YDWP, its employees, board members, agents, directors, and contractors from all claims arising from any occurrence caused by negligence, breach of contract or otherwise, for bodily injury, death, damage to or theft of personal property of me or to any party participating in said event or any third parties injured as a result of me. I further agree to repair or reimburse YDWP for any and all damages that I negligently or intentionally cause to YDWP property.
PHOTO, AUDIO-VISUAL RECORDING RELEASE
I hereby grant YDWP the right and permission to use, reuse, and/or publish photographic and/or video materials taken of me while participating or volunteering with YDWP. I understand that these photographs and audio/videotapes are used in educational settings, to promote and advertise programs and/or in professional publications. I further understand that these materials can be used without limitation, reservation, or compensation. I waive any right to inspect and/or approve the photograph and/or audio-videotape. This consent is given for any photographs and/or audio-videotapes which have been taken, are about to be taken, or will be taken.
I have carefully read this agreement and understand the terms and conditions. I am aware that this agreement includes a release of liability, and is a binding contract between YDWP and myself, and it likewise shall be binding on my heirs, executors, administrators and assignees.