Waiver and Release of Liability Form
I hereby give my permission for my child to participate in EarthWalk Summer Camp at Matsinger Forest in Danville.

I understand that EarthWalk Camp activities such as, hiking, running, playing games, wood-carving, using tools, engaging in activities in the forest, meadow, and wetlands my child could get hurt and/or encounter mosquitos, bees, ticks, poison ivy, low lying branches, and slippery and jagged surfaces, among other inherent dangers and risks. 

I also understand that outdoor activities may occur in the hot sun, in the rain or stormy weather. I agree to see that my child is appropriately attired for all activities, and carries necessary extra items they may need such as sunscreen, rain jacket or extra layer of clothing, and is prepared for the variable, often changing weather conditions.

The EarthWalk staff are trained in dealing with emergency situations and will strive to always safeguard all children’s physical and social wellbeing. I accept the safety considerations and any agreements set down by EarthWalk staff to minimize these risks.

In the event of illness, injury, and/or accident, I authorize the EarthWalk staff to act on my behalf. They may approve any and all non-emergency or emergency treatment and are authorized to sign any and all medical release or required form(s) on my behalf. In the event of an emergency, I understand that I will be notified of the situation as soon as practicable. I agree to pay any necessary expenses incurred in the medical treatment of my child.

I understand that the EarthWalk staff may, in its sole discretion, dismiss any child for inappropriate, disrespectful, or dangerous behavior at any time. If my child breaks or damages any property as a result of their direct or indirect behavior, I hereby agree to pay for its repair or replacement. 

I am fully aware of these risks, and realize that injuries are a possibility no matter how attentive a caregiver/instructor may be. I hereby assume these risks and, knowing them, hereby give my child permission to participate. I accept the full responsibility for any such damage or injury of any kind that may result from the actions of my child enrolled in EarthWalk Summer Camp.

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Child's Name

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Please check all that apply below: *
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My child may use a whittling knife, only after passing a knife safety test, and under direct supervision. (We have a set of EarthWalk knives for use).

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My child may use use all hand-tools, such as a bow saw, hatchet, or draw-knife only with permission, and under direct supervision.

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My child may remove their shoes and walk barefoot, with permission and when they can do so safely (in warm weather and during appropriate activities).

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I allow my child’s photo, video, or film likeness to be used for any legitimate purpose by the activity holders, producers, sponsors, organizers, and assigns. (For future grant funding, program development etc.).

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By signing (typing) my name below, I expressly release and hold harmless EarthWalk staff, its officers, directors, employees, agents, licensees, successors and assigns from and for any and all claims, demands or causes of action which you have or may have for (i) libel, defamation, invasion of privacy or right of publicity arising from EarthWalk Summer Camp’s use of Recordings or (ii) on account for any loss, damage or injury to person or property suffered or incurred by you or your child, except by any gross negligence, in connection with any aspect of your child’s participation in EarthWalk Summer Camp.

I CERTIFY THAT I HAVE READ THIS DOCUMENT, FULLY UNDERSTAND ITS CONTENT, AND AGREE TO ITS TERMS.  

Parent/Guardian Name:

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A copy of your responses will be emailed to the address you provided.
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