Annual Program Release Form : What We Do : Tin Mountain Conservation Center

ANNUAL FIELD PROGRAM RELEASE FORM: Coverage for the 2024 Calendar Year

Participant’s Name

First Name

Last Name

Release form: I am a participant in the Field Programs for the calendar year 2024, that are organized and administered by Tin Mountain Conservation Center. I am familiar with and recognize the risks inherent in these programs. I assume all the risks of injury and / or loss arising or resulting from my participation, hereby releasing and holding harmless Tin Mountain Conservation Center, its employees, or agents, from liability for any such injury or loss.

Tin Mountain Conservation Center may use photographs taken during the program in which I may appear, for promotion, marketing and advertising Tin Mountain Conservation Center including but not limited to publications, social media, emails and marketing materials.

I do NOT want my photograph used by Tin Mountain Conservation Center.

I do NOT
I do

Please list any medical concerns pertinent to this activity

Emergency Contact Name

First Name

Last Name

k2lj4knz1l74

Emergency Contact’s Phone Number

It is the participant’s responsibility to update Tin Mountain Conservation Center of any changes in medical concerns and contact information.

Participant’s Signature (initials)

Date

Month

Day

Year

I understand that my initials on this online form serve as my signature.