WAIVER OF LIABILITY AND HOLD HARMLESS AGREEMENT
Before attending a hike with Chicana In Nature, this form needs to be completed. Please initial in the short answer sections. Thank you.
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Email *
Parent/Guardian First & Last Name
Minor Child's First and Last Name *
I am the parent/guardian of my child. I hereby grant Chicana In Nature, LLC and their staff the absolute right and permission to use photographic portraits, pictures, digital images or video of my child, or in which my child may be included in whole or part, or reproductions thereof in color or otherwise for any lawful purpose whatsoever, including but not limited to use in any Chicana In Nature publication, on the Chicana In Nature website, or Chicana In Nature social media without payment or any other consideration. I hereby waive any right that I may have to inspect and/or approve the finished product or the copy that may be used in connection therewith, wherein my child’s likeness appears, or the use to which it may be applied.I hereby release, discharge, and agree to indemnify and hold harmless Chicana In Nature, LLC, and their staff from all claims, demands, and causes of action that I or My Child have or may have by reason of this authorization or use of My Child’s photographic portraits, pictures, digital images or videotapes, including any liability by virtue of any blurring, distortion, alteration, optical illusion, or use in composite form, whether intentional or otherwise, that may occur or be produced in the taking of said images or videotapes, or in processing tending towards the completion of the finished product, including publication on the internet, in brochures, or any other advertisements or promotional materials.I represent that I am at least eighteen (18) years of age and am fully competent to sign this Release.
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In consideration for receiving permission to participate in a hike with Chicana In Nature,  I [and/or for my child] hereby RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE  Chicana In Nature,  Susana M. Cruz, servants, agents, or employees (hereinafter referred to as RELEASEES) from any and all liability, claims, demands, action and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by me, or to any property belonging to me, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES, or otherwise, while participating in such activity, or while in, on or upon the premises where the activity is being conducted. *
Chicana In Nature, LLC will be utilizing a reptile for educational purposes during the activity. I [and/or for my child] hereby elect to voluntarily participate in said activity, and to enter the above-named premises and engage in such activity knowing that certain risk of harm are or may be inherent in the various activities contemplated herein and that the activity may be hazardous to me and my property.  I VOLUNTARILY ASSUME FULL RESPONSIBILITY FOR ANY RISKS OF LOSS, PROPERTY DAMAGE OR PERSONAL INJURY, INCLUDING DEATH, that may be sustained by me, or any loss or damage to property owned by me, as a result of being engaged in such an activity, WHETHER CAUSED BY THE NEGLIGENCE OF RELEASEES or otherwise.
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I [and/or for my child] hereby elect to voluntarily participate in said activity, and to enter the above-named premises and engage in such activity knowing that certain risk of harm are or may be inherent in the various activities contemplated herein and that the activity may be hazardous to me and my property.  I VOLUNTARILY ASSUME FULL RESPONSIBILITY FOR ANY RISKS OF LOSS, PROPERTY DAMAGE OR PERSONAL INJURY, INCLUDING DEATH, that may be sustained by me, or any loss or damage to property owned by me, as a result of being engaged in such an activity, WHETHER CAUSED BY THE NEGLIGENCE OF RELEASEES or otherwise. *
I [and/or for my child] further hereby AGREE TO INDEMNIFY AND HOLD HARMLESS the RELEASEES from any loss, liability, damage or costs, including court cost and attorney's fees, that they may incur due to my participation in said activity, WHETHER CAUSED BY OR CONTRIBUTED TO IN WHOLE OR PART by any action or failure to act, negligence, breach of contract, or other misconduct on the part of RELEASEES or otherwise. *
It is my [and/or for my child] express intent that this Release and Hold Harmless Agreement shall bind the members of my family and spouse, if I [and/or for my child] am[is] alive, and my heirs, assigns and personal representative, if I [and/or for my child] am[is] deceased, and shall be deemed as a RELEASE, WAIVER, DISCHARGE AND COVENANT NOT TO SUE  the aboved named RELEASEES.  I [and/or for my child] hereby further agree that this Waiver of Liability and Hold Harmless Agreement shall be construed in accordance with the laws of the State of Texas. *
IN SIGNING THIS RELEASE, I [and/or for my child] ACKNOWLEDGE AND REPRESENT THAT I have read the foregoing Waiver of Liability and Hold Harmless Agreement, understand it and sign it voluntarily as my own free act and deed; no oral representations, statements, or inducements, apart from the foregoing written agreement, have been made; I am at least eighteen (18) years of age and fully competent; and I execute the Release For full, adequate, and complete consideration fully intending to be bound by same. *
A copy of your responses will be emailed to the address you provided.
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