Field Trip Liability/Photography Release
Field Trip
9/30/16
Participant's Name: *
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Participant's Age: *
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School/Group Name: *
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Location: Waiahole Nursery and Garden Center
I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING AND/OR VOLUNTEERING IN THIS
ACTIVITY OR EVENT, including by way of example and not limitation, any risks that may arise from negligence or
carelessness on the part of the persons or entities being released, from dangerous or defective equipment or
property owned, maintained, or controlled by them, or because of their possible liability without fault. I certify that I am
physically fit, have sufficiently prepared or trained for participation in the activity or event, and have not been advised
to not participate by a qualified medical professional. I certify that there are no health-related reasons or problems
which preclude my participation in this activity or event. I acknowledge that this Accident Waiver and Release of
Liability Form will be used by the event holders, sponsors, and organizers of the activity or event in which I may
participate, and that it will govern my actions and responsibilities at said activity or event. In consideration of my
application and permitting me to participate in this event, I hereby take action for myself, my executors, administrators,
heirs, next of kin, successors, and assigns as follows:
(A) I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from
the negligence or fault of the entities or persons released, for my death, disability, personal injury, property damage,
property theft, or actions of any kind which may hereafter occur to me including my traveling to and from this event,
THE FOLLOWING ENTITIES OR PERSONS: Waiahole Nursery, their directors, officers, employees, volunteers,
representatives, and agents, the activity or event holders, activity or event sponsors, activity or event volunteers;
(B) I INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this
paragraph from any and all liabilities or claims made as a result of participation in this activity or event, whether
caused by the negligence of release or otherwise. I acknowledge that Waiahole Nursery and their directors, officers,
volunteers, representatives, and agents are NOT responsible for the errors, omissions, acts, or failures to act of any
party or entity conducting a specific event or activity on behalf of Purdue University.
I acknowledge that this activity or event may involve physical activity, and may carry with it the potential for death,
serious injury, and property loss. I hereby consent to receive medical treatment which may be deemed advisable in
the event of injury, accident, and/or illness during this activity or event.

I CERTIFY THAT I HAVE READ THIS DOCUMENT, AND I FULLY UNDERSTAND ITS CONTENT. I AM
AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE
WILL.

PARENT / GUARDIAN WAIVER FOR MINORS (Under 18 years old)
The undersigned parent and natural guardian does hereby represent that he/she is, in fact, acting in such capacity,
has consented to his/her child or ward’s participation in the activity or event, and has agreed individually and on
behalf of the child or ward, to the terms of the accident waiver and release of liability set forth above. The
undersigned parent or guardian further agrees to save and hold harmless and indemnify each and all of the parties
referred to above from all liability, loss, cost, claim, or damage whatsoever which may be imposed upon said parties
because of any defect in or lack of such capacity to so act and release said parties on behalf of the minor and the
parents or legal guardian.

AGREEMENT: By signing this Electronic Signature Acknowledgment Form, I agree that my
electronic signature is the legally binding equivalent to my handwritten signature. Whenever I
execute an electronic signature, it has the same validity and meaning as my handwritten signature.

Parent/Guardian's Electronic Signature (Print full name): *
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Phone Number: *
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Today's Date: *
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Photography Release
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