RELEASE OF LIABILITY FOR CHILD PARTICIPANT

Childs Name:___________________________________
Date of Birth:___________________________________

Site: Festival Event Sites listed in the 2003, Great River Birding Festival Program
Date of Activity: May 9th, 10th, and or 11th
Activity: Great River Birding Festival
Activity Leader: Audubon & Mississippi Valley Partners


I/we, __________________________________________, the parent(s) and or legal guardian(s) of the above referenced child, wish for him/her to participate in National Audubon Society, Inc.s (Audubon) and Mississippi Valley Partners festival program, the Great River Birding Festival.

I/we agree that we are allowing our child to participate in the activities at their own risk, and acknowledge that Audubon and Mississippi Valley Partners have made no warranty or representation, expressed or implied, regarding the safety of conducting the activities.

I/we expressly release and hold harmless Audubon and Mississippi Valley Partners and their officers, directors, employees, and agents from and for any and all claims, demands, actions and causes of action whatsoever on account of any loss, damage or injury to person or to property suffered or incurred by my/our child regardless of the cause thereof in connection with the Program or any aspect of it. This is including, but not limited to, any transportation arranged by, paid for, or provided by Audubon and Mississippi Valley Partners.

This release shall be binding upon me/us and my/our heirs, next of kin, executors, administrators and assigns.


Parent/Guardian Signature:_____________________________________
Print Name:_________________________________________________
Address:____________________________________________________
___________________________________________________________
Date:_______________________________________________________


Parent/Guardian Signature:_____________________________________
Print Name:_________________________________________________
Address:____________________________________________________
___________________________________________________________
Date:_______________________________________________________

Back Home Back to Top