Field Trip Signup and Outing Liability Waiver. Trip: Date: Leader:

Similar documents

Participation Agreement Legal Document

Facility Rental Information - Summer

THEATRE WINTER HAVEN S COMMUNITY DANCE CENTRE

Entertainment Application

BROADWAY THEATER RENTAL PACKET

A MIDI/MP3 actualization or recording of the composition (digital file, web link, or audio CD)

DocuSign Envelope ID: D1ADA4EE B71F-10F64687F4EB

Country Heritage Park Presents 3rd Annual Art-in-the-Park Art Show & Sale Sunday, August 12 th, a.m. 5 p.m.

2019 UPA IRON BATTLE ON THE MISSISSIPPI July 13 th & 14 th, XPC Arnold Classic Qualifier

24-HOUR WEIGH-IN RULE APPLIES Weigh INS. NO SAME DAY WEIGH INS * The Grand River Center 500 Bell St. Dubuque, IA 52001

2 Canton Street, Suite A-8 Stoughton, MA Summer Stock Registration Form

ADVANCED TELEVISION SYSTEMS COMMITTEE, INC. CERTIFICATION MARK POLICY

Camping, Base. Activity scope. Risk level

2 Canton Street, Suite A-8 Stoughton, MA theconservatoryschool.com

Sue Shuttleworth Music Therapy Clinic

Western Piedmont Youth Symphony - Conductor David Wortman Rehearsal and Concert Schedule Season

Elbert Theatre Rental Application

INFORMATION TECHNOLOGY POLICY FOR THE RENTAL OF. The Township of Radnor Conference Rooms and Equipment

Application Instructions Please make sure to follow all instructions

CAROLINA YOUTH CHORALE INFORMATION AND REGISTRATION

Producer s Signature

SUBWAY MUSICIANS APPLICATION FOR AUDITION PACKAGE

City of Rialto California

4th Annual Hog Fest in Historic Edenton

2008 CREDENTIAL MEMO

2012 Product Theater the 2012 Fall Meeting Product Theater Half-hour slots are only available if the one-hour time slots are not reserved.

Nutcracker Audition Information Packet 2017 MetroWest Ballet

FRIDAY, FEBRUARY 2, 2018

GOSHEN PLAYERS, INC. VOLUNTEER USHER GUIDE. Volunteer Basics

Dear Fellow Educator:


OREGON CONFERENCE TLT CONVENTION Camp Angelos, Corbit, OR Jan , 2019 TABLE OF CONTENTS

To participate in Lights, Camera, Music! your group must audition by following steps 1, 2, 3 and 4 below:

CKSD Eastside Elementary Jazz Ensemble All 5 th and 6 th grade band/orchestra members are invited to try out for the CKSD Eastside Elementary Jazz

Children cannot always recognize potential hazards properly. This 5.1 system is not designed for operation in a heavy industry environment.

Clayton County Performing Arts Center 2530 Mount Zion Parkway Jonesboro, Georgia 30236

Component Video + Analog/Digital Audio Wall Plate (6-RCA) AT80COMP7

BUTLER COMMUNITY ARTS SCHOOL SUMMER CAMP REGISTRATION FORM 2015

BeckRidge Productions Koppernick Road Canton, MI Village Theater at Cherry Hill Cherry Hill Road Canton, MI 48188

Installation Guide. Table of Contents: HotLok Full Rack Blanking Panel Kit. Mounting Extrusion. HotLok Blanking Panel. HotLok Blanking Sheet

SUMMER CELLO INTENSIVE APPLICATION July 16-21, 2018

* Subject to certain restrictions and availability. Member may be required to be present with membership card to receive discounts.

Summer Camps Ages: 7-14 Cost: $290 Musical Director: Dan Bruce 8:30 a.m. 4:00 p.m.

Level 2 Digital Electronics 2 ( )

Low Voltage Multifunctional LED Controller / DMX Decoder. Specification

SAVIOR S SINGERS. Directed by Kristi Holden (704)

2019 Placitas Studio Tour Guidelines. Our Doors Are Open

Company Member s Signature: Parent/Guardian Signature of a Minor: PHOTO RELEASE

Tampa Bay Performing Arts Academy

TABLE OF CONTENTS PAGE

Pearland Foundation for the Performing and Visual Arts

HSK Mine and Portable Cable Splice

APPLICATION FOR TEEN ART EXHIBITS

SATURDAY, FEBRUARY 10, 2018

Mundelein One World Festival Food, Drink, and Entertainment from Around the World. Sponsor Application

MUSICIANS HANDBOOK. I would like to welcome you to the Red Note Youth Orchestra (RNYO)!

Summer Camps Ages: 9-17 Cost: $290 Musical Director: Dan Bruce 8:30 a.m. 4:00 p.m.

WHEN: Saturday, WHERE: Arts Young Circle, Hollywood, FL. TIME: 4:00pm-9:00pm. December 10, 2016

Sunday - July 31, 2016

TERRITORIAL SCHOOL OF MUSIC AND GOSPEL ARTS August 26 September 2, 2006

GLENNVILLE CITY AUDITORIUM 207 TILLMAN STREET GLENNVILLE, GEORGIA TELEPHONE NUMBER: (912)

Loctite. EQUIPMENT Operation Manual. Zeta 7011-A Dosimeter-Radiometer for UVA Part Number 98086

This packet contains important information about the audition process, rehearsals, and the performances. Please read this before you fill out the

Miniature Fiber Optic 3G/HD/SD-SDI Digital Video Extension Kit up to 1200ft. AT-3GSDI20SR

TABLE OF CONTENT GUIDE FOR NEW MEMBERS. Page 1 Who We Are Membership Information

Performance Information Band & Honors Solo Vocal

Summary of process for renting the Bus Stop Theatre Cooperative Space:

X X X Ad in printed event guide Full Page ½ Page ¼ Page Option to purchase additional sponsorship items

EASY SET UP GUIDE. Thank you! You now own Flapit. Tell us about Flapit and you #flapitcounter

Final Act Drama. Theater / Dance / and other special skills

Monty s Rewards Gift Card Terms and Conditions. activate means that initial loading of value onto a Monty s Rewards Gift Card.

1 x 3 Component Video W/Audio Distribution Amplifier AT-COMP-13AD

Application Form A of 2016 NTD International Piano Competition

User Manual. 1x8 S-Video Distribution Amplifier With Stereo Audio AT-SAV18

3M Cold Shrink Foldback Splice Jacket Kit

Quick Start Guide ABOUT THE CAMERA

San Dieguito Union High School District MiniCine FEST: A 48-Hour Film Competition (Presented by Envision Cinema & CCA-TV)

Discipleship Bible School Application

LIABILITY RELEASE / WAIVER FORM

LIBERMAN BROADCASTING, INC.

APPENDIX J Richmond High School Performing Arts Theater Usage Policy (December 2018)

LG Digital Broadcast Studio Studio Usage Policy & Procedures

Photovoltaic Module Installation Manual (IEC)

Be sure to check the camera is properly functioning, is properly positioned and securely mounted, every time you operate your vehicle.

INTEGRITY & LIFESTYLE QUESTIONNAIRE

High School Opera Singers Intensive Application

User Manual. 4x2 Composite Video/S-Video/Analog Audio Matrix Switcher AT-SAV-42M

The Elbert Theatre Rental Application Packet

Birdman Jump - Saturday 14 th July

User Manual. VGA to Component or Component to VGA Converter Scaler AT-VGA300CV

Community Center Facility Rental Policies

MWT-FM. Operation Manual. FM Single Channel Transmitter. man_mwtfm.

Utility Amplifier GA6A Model

Instant 802.3af Gigabit Outdoor PoE Converter. Model: INS-3AF-O-G. Quick Start Guide

TERMS AND CONDITIONS GOVERNING OFFERS AVAILABLE IN VODAFONE RED POSTPAID PLANS

Dear EMF Session I Students and Parents:

Photovoltaic Module Installation Manual (IEC)

DisplayPort to VGA Converter

ADC 2015 Exhibitor & Sponsor Prospectus

Transcription:

Field Trip Signup and Outing Liability Waiver Trip: Date: Leader:

GEORGIA BOTANICAL SOCIETY Outing Liability Release I, whose name and signature is included on this form, have chosen to participate in this trip, field trip, or outing sponsored by the Georgia Botanical Society as indicated on the front of this form "the outing." In consideration for being allowed to participate, I willingly assume all risks associated with my participation and I grant this release of liability. I have listened carefully to the hazards outlined by the outing leader. I understand that my participation in this outing entails a risk of physical injury or death, and that I may be exposed to extreme or inclement weather; passage on or through bodies of water (including exposure to white water, strong currents, rocks, snags and similar hazards); unmarked and unprotected topographic hazards such as cliffs, ravines, caves, or falling rocks; exposure to poisonous insects, reptiles or plants; and risks associated with strenuous physical activity. I further understand that accidents or injuries may occur in locations or under circumstances where medical attention is not readily available. I expressly assume all risks associated with such hazards, as well as all other risks associated with or arising from my participation in this outing. I understand and agree to abide by all instructions, rules and regulations of the leader designated by the Georgia Botanical Society regarding safety and the use of all equipment. I understand that no drugs or alcoholic beverages of any type are allowed, and I will be asked to leave if I am suspected to be under the influence of drugs or alcohol. On behalf of myself, my estate and personal representative thereof, my heirs and assigns, I hereby forever release the Georgia Botanical Society, its officers, directors, and agents from any and all costs, claims, losses, liabilities or damages arising from or in any way related to my participation in this outing. I intend this release to be effective, regardless whether the claim of liability is asserted in negligence, strict liability in tort, or other theory of recovery. For myself, my estate, and the personal representative thereof, my heirs and assigns, I covenant and agree to make no claim, nor to institute any suit, action or proceeding against the Georgia Botanical Society, its officers, directors or agents, relating to any accident, incident or occurrence arising out of or in connection with my participation in this outing. IN WITNESS WHEREOF, I have executed this release by my signature on this form; and for my children, wards or assigns by their written name and my signature. I acknowledge that a copy of this statement has been made available to me by my signature on this form.

1) Printed name Signature 2) Printed name Signature 3) Printed name Signature 4) Printed name Signature 5) Printed name Signature 6) Printed name Signature 7) Printed name Signature 8) Printed name Signature 9) Printed name Signature 10) Printed name Signature 11) Printed name Signature 12) Printed name Signature 13) Printed name Signature 14) Printed name Signature 15) Printed name Signature

16) Printed name Signature 17) Printed name Signature 18) Printed name Signature 19) Printed name Signature 20) Printed name Signature 21) Printed name Signature 22) Printed name Signature 23) Printed name Signature 24) Printed name Signature 25) Printed name Signature 26) Printed name Signature 27) Printed name Signature 28) Printed name Signature 29) Printed name Signature 30) Printed name Signature

31) Printed name Signature 32) Printed name Signature 33) Printed name Signature 34) Printed name Signature 35) Printed name Signature 36) Printed name Signature 37) Printed name Signature 38) Printed name Signature 39) Printed name Signature 40) Printed name Signature 41) Printed name Signature 42) Printed name Signature 43) Printed name Signature 44) Printed name Signature 45) Printed name Signature