Ventura Wild Participant Waiver
For valuable consideration and in order to induce permission to allow my/our child, to participate in the outdoor education and adventure programs (hereinafter, the “Programs”) provided by Ventura Wild (hereinafter, “Ventura Wild”), the undersigned, individually and as the parent(s) and/or legal guardian(s) of the below-named Participant, do hereby agree as follows:

Acknowledgement of Risks: I/we recognize that there are certain inherent risks and potential hazards associated with the activities in which Participant will participate during the Programs, including the risk of serious bodily injury and/or property damage. Such activities include, but are not limited to Exploring off-trail, Swimming, Climbing trees, Rock hopping and hiking, Whittling and carving with a knife, Going barefoot, Foraging and cooking with wild edible plants, Playing in general. Such activities involve known and unanticipated risks that could result in physical or emotional injury, paralysis, death, or damage to Participant, Participant’s property, and/or the person or property of third parties, resulting from but not limited to: Falls of all kinds , Heat-related illnesses, Cold-related illnesses, An “act of nature”, Contact with plants or animals, Equipment failure, Varying weather conditions, A participant’s ability to follow directions.

I understand that such risks may result from, among other causes, the active or passive negligence of Ventura Wild, its agents, employees, volunteers, instructors, vendors, suppliers, or representatives, including but not limited to negligent instruction or supervision.

I/we acknowledge that I/we have been fully informed as to the nature of said activities and the provisions for my/our child’s involvement and consent to my/our child’s participation therein. I/we have considered all of the risks related to my/our child’s participation in the Programs and, with this in mind, I/we, on behalf of myself/ourselves and Participant, accept full responsibility for and expressly assume all risk of bodily injury, death or damage to any person or property, whether foreseen or unforeseen, that may be caused by or otherwise arise from such activities. I/we hereby further expressly release and forever discharge Ventura Wild, Ventura Land Trust, and their respective principals, agents, officers, directors, employees, volunteers, instructors, vendors, suppliers, representatives, affiliates, successors and assigns, and all other persons acting for, under or in concert with them or any of them (collectively, “Ventura Wild Releasees”), and agree to indemnify, defend and hold harmless said Ventura Wild Releasees, from and against any and all claims, demands, suits, actions, causes of action, judgments, obligations, damages, liability, responsibility, losses, costs or expenses, including attorneys’ fees and other litigation costs, of any kind or nature whatsoever (collectively, “Claims”), whether foreseen or unforeseen, direct or indirect, on account of, or in any way growing out of, any bodily injury or property damage of any kind in any manner resulting from, arising out of, or connected with Participant’s participation in the Programs. The foregoing shall include, without limitation, any personal injury, death, or property damage caused by the active or passive negligence of Ventura Wild and/or any Ventura Wild Releasees.

The undersigned further covenant and agree, for the consideration provided above, never to make, assert, commence, prosecute or maintain, either individually or on behalf of any other person and/or entity, any claim, demand, action, cause of action or proceeding, whether judicial or administrative, against any Ventura Wild Releasee based upon any such Claim hereby waived, released and discharged.

Release of Liability: I/we understand and acknowledge that the foregoing release of liability applies to and includes all unknown or unsuspected consequences or results arising from or relating to Participant’s participation in the Programs. In connection therewith, I/we desire to extend the release as fully as possible and to expressly waive any limitation on the effect of said release as set forth in Section 1542 of the California Civil Code, or any other provisions of law, which may limit the effectiveness of the release. I/we acknowledge that I/we have read and understand Section 1542 of the California Civil Code, which states:
“A GENERAL RELEASE DOES NOT EXTEND TO CLAIMS THAT THE CREDITOR OR RELEASING PARTY DOES NOT KNOW OR SUSPECT TO EXIST IN HIS OR HER FAVOR AT THE TIME OF EXECUTING THE RELEASE AND THAT, IF KNOWN BY HIM OR HER, WOULD HAVE MATERIALLY AFFECTED HIS OR HER SETTLEMENT WITH THE DEBTOR OR RELEASED PARTY.”

Notwithstanding said Section 1542, I/we agree that this release shall act as a release of all future Claims that may arise from the above-described released matters, whether such Claims are currently known or unknown, foreseen or unforeseen, suspected or unsuspected, actual or potential, absolute or contingent, pending or anticipated, including without limitation, any claim for damages as yet not incurred; and I/we intentionally and specifically waive any rights I/we may have under the provisions of said Section 1542, as well as under any other statutes or common law principles of similar effect, and assume full responsibility for such injuries, damages, losses or liabilities that I/we may hereafter incur with respect to such Claims. I/we fully understand that if the facts in respect to which this release was executed are found hereafter to be different from facts now believed by me/us to be true, I/we expressly accept and assume the risk of such possible difference in facts and agrees that this release shall remain effective, notwithstanding such differences.
Participant Name *
Parent/Guardian Name *
I represent and warrant that the Participant is my child. I am entering into this Participant Agreement, Release and Assumption of Risk on his or her behalf. I represent and warrant that I have the legal authority to do so. I further agree to release and indemnify Ventura Wild from any and all claims which are brought by or on behalf my child and which are in any way connected with his or her participation in Ventura Wild’s programs. *
Required
In my capacity as parent or legal guardian, I hereby acknowledge the health risks and dangers associated with the transmission of the COVID-19 virus, and other communicable diseases, and recognize that exposure to the COVID-19 virus, or other communicable diseases, could occur while my child is in the care of Ventura Wild. *
Required
Medical & Personal Information
PLEASE Check APPROPRIATE RESPONSE: *
YES
NO
Any medical conditions which restrict participation in vigorous physical activity
Allergies to food, insects or plants of any kind
History of asthma
History of seizures
Does your child carry an inhaler, epinephrine pen or other emergency medication
Regular medication being taken that we should know about
Recent surgery or other pertinent medical information
**PLEASE PROVIDE DETAILS FOR “YES” RESPONSES ABOVE:
Can your child swim? *
Has your child had a bee sting? *
If yes, did your child have an allergic reaction to that bee sting?
Clear selection
Does your child have any physical, sensory, cognitive, or emotional disabilities (including ADD/ADHD, sensory processing, autistic spectrum)? *
If yes, please describe.
**Please share with us any other physical or emotional ways your child might need extra support or awareness:
Ventura Wild Medical Treatment Authorization: I understand that I can lessen the inherent risks of outdoor activities at Ventura Wild by filling this form out in detail and carefully following the “To Bring” list. The above information is accurate and complete. I have read and understood the foregoing acknowledgement of risks, assumption of risks and responsibility, and medical authorizations. *
Required
In the event that this participant requires immediate medical attention, I hereby give my permission for a licensed physician or nurse to administer treatment as necessary. *
Primary Emergency Contact (Parent/Guardian Name, Relationship to participant) *
Emergency Contact Phone Number *
Secondary Emergency Contact (Parent/Guardian Phone Number)
Doctor's Name
Doctor's Phone Number
Medical Insurance Company
Policy Number
Group Number
Policy Holder Name
Media Release: Use of images for publication - Pictures and videos taken of the Ventura Wild program and participants may be used for publicity and publication. I understand and agree to my child being pictured or quoted in Ventura Wild materials. I understand these materials are to educate and inform about the program.
I have had sufficient opportunity to read this entire document. I have read and understood it, and I agree to be bound by its terms. I acknowledge that Ventura Wild is materially relying on this waiver in allowing me to engage in its programs. *
Required
I RECOGNIZE THE FACT THAT THERE ARE RISKS IN OUTDOOR ACTIVITIES with Ventura Wild. These risks may result in self injury or loss of life, and include but are not limited to: Falls, Drowning, Heat related illnesses, Allergies, An “act of nature”, Contact with plants or animals, Equipment failure, Varying weather conditions, A participant’s sense of balance, Ability to follow directions. I realize that certain unforeseen events can contribute to the unpredictability of the resulting dangers and hazards of outdoor education, and I should ask about other potential risks, dangers, and hazards and recommended precautions. *
Required
EXPRESS ASSUMPTION OF RISK AND RESPONSIBILITY: In recognition of the risks involved in any outdoor activity, I agree that my child named above is physically and mentally capable of participating in the outdoor activities. His or her participation is voluntary and I will assume financial responsibility of personal injury, accidents, illness or death. I also accept responsibility for damage of personal property as the result of any accident that may occur. *
Required
By checking here, I am effectively providing my signature, indicating that all the information on this form is true and accurate, to the best of my knowledge, and I agree to the terms and statements above. *
Required
Signature of Parent / Guardian *
Date *
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Thank You!
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