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

Field Program Release Form

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Name of Program

Date of Program

Month

Day

Year

Participant’s Name

First Name

Last Name

Release form: I am a participant in __________________________ (name of program), which is organized and administered by Tin Mountain Conservation Center. I am familiar with and recognize the risks inherent in this program. 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. Unless otherwise informed, 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.

Photography

Please do Not use my image

Please list any medical concerns pertinent to this activity:

Emergency Contact Name

First Name

Last Name

Emergency Contact’s Phone Number

Participant’s Signature (initials)

Date

Month

Day

Year

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