Treks Registration - Thousand Islands Land Trust

Name

This field is for validation purposes and should be left unchanged.

Name(Required)

First Last

Email(Required)

Phone

What is the name of the event you're registering for?(Required)

Release of Liability

Are you 18 years of age or older?(Required)

(Parent or guardian must sign below if under 18)

Yes

Name of Participant(s) (Can name more than one partcipant)(Required)

First Last

Address

Street Address City State ZIP Code

In Case of Emergency Notify(Required)

Emergency Notify Phone(Required)

Consent(Required)

In consideration of my participation in this field trip and intending to be legally bound, I hereby waive, release and forever discharge any and all rights, actions and claims, either in law or in equity, which I or my heirs, executors or assigns may have against the Thousand Islands Land Trust, (“TILT”), its respective officers, directors, trustees, employees, volunteers, hosts, representatives, successors, assigns and affiliates (“releases”) for death, injury, loss, and any and all damages which may be sustained and or suffered in connection with my participation in the field trip. The undersigned assumes full responsibility, and risk of, bodily injury, death or property loss that can occur due to participation in the field trip whether caused by the negligence of TILT or its officers, directors, trustees, employees, volunteers or agents or otherwise. The undersigned also understands that TILT does not assume any responsibility for or obligation to provide financial assistance or other assistance, including but not limited to medical, health, or disability insurance in the event of injury or illness.

For good consideration, the undersigned hereby releases, discharges, and acquits TILT, its successors, assigns and personal representatives from any claim or liability arising from my participation in this field trip.

I hereby grant the Thousand Islands Land Trust permission to use, for promotional purposes, photographs taken during my trek.

I hereby grant the Thousand Islands Land Trust permission to use my email address for the purpose of sending me emails.

If the participant is a minor, I agree that the minor has my consent to participate in the event or activity. I further provide my consent for TILT to seek emergency treatment for the minor if necessary. I agree to accept financial responsibility for the costs related to this emergency treatment. I understand that on occasion TILT uses photos from events and treks on its website and/or for publicity. I also understand that TILT will never identify any minors in these photos by name. Please note local publications often require all names of individuals in photos be provided for publishing.

THIS IS A RELEASE AND WAIVER OF LEGAL RIGHTS. READ BEFORE SIGNING.

I agree to the release of liability

Signature of Participant(Required)

Name of Parent or Guardian(Required)

First Last

Signature of Parent or Guardian(Required)