NEPARC PARTICIPANT AGREEMENT

Assumption of Risk, Release/Waiver of Claims, Medical Consent, & Media Release

The Northeast chapter of Partners in Amphibian and Reptile Conservation (“PARC”) welcomes your participation in the following activity (“Activity”).

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Email *
Activity Description *
My Name *
Email Address *
Phone Number *
Date  *
MM
/
DD
/
YYYY
I am at least 18 years of age and am competent to contract in my own name. I have read this document before signing and I fully understand its contents, meaning and impact. *
Required
Emergency Contact Name *
Emergency Contact Phone *
If Participant is a minor (under 18 years of age), a Parent or Legal Guardian accepts responsibility and must sign below:
In consideration of my child’s participation in the Activity, I expressly acknowledge and agree to, on behalf of myself (and my child), my heirs, executors, administrators, successors and assigns, the terms of this Participant Agreement set forth above.  I am at least 18 years of age and am competent to contract in my own name and on behalf of my child.  I have read this document before signing below and I fully understand its contents, meaning and impact. I also understand that my consent on behalf of my child will be effective even after she/he reaches the age of majority. 
Child's name
Child's Age
A copy of your responses will be emailed to the address you provided.
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