Conservation Kids: Registration & Release

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Time: 10 am - 2 pm
Location : Izaak Walton League, 450 Beisseinger Road, Hamilton 45013

By completing and submitting this form, I agree to the conditions listed below:

Risk & Release Waiver

I recognize there are certain risks of injury as a result of my (or my child’s) participation in this activity. I agree to assume the full risk of any injuries, damages, or loss which I (or my child may) sustain as a result of participating in any and all of the activities connected with or associated with this program, or products provided, including allergic reactions to foods consumed. I agree (for and on behalf of myself and my child/ward) to, and do hereby waive and relinquish any and all claims against, and agree to full release, hold harmless, and indemnify, the Hamilton Chapter of the Izaak Walton League of America (IWLA) members and officers, and the Butler Soil and Water Conservation District’s (SWCD) Board of Supervisors, its officers, employees, agents, and volunteers from any and all claims related to any illness, injury, including loss of life, property damage, or loss of any description, which I (or my child/ward) may sustain arising out of, or in any way associated with my (or my child’s/ward’s) participation in the Conservation Kids program.

Consent to Treat

In the event of injury or illness, I authorize (on behalf of myself or my child/ward) Butler SWCD and/or Hamilton Chapter of the Hamilton Chapter of the IWLA to obtain first aid and/or medical treatment at the nearest and most adequate facility of Butler SWCD or Hamilton Chapter of the IWLA’s choice. This release is competed and signed of my own free will and with the sole purpose of authorizing medical treatment under emergency circumstances for myself, or in my absence, for the minor child/ward listed.

Photo Release

I authorize the Hamilton IWLA and Butler SWCD staff to publish, in print, electronic, or video format, the likeness or image of myself or my child/ward, without limitation.

Child's Name (if you are completing this form for multiple children, please place their age next to their name)
*

Is a sibling(s) attending; if so, what is the siblings name(s)? (this will allow us to make a determination on whether or not to take an extra child if we are full)

Child's Age *

Required

Any special needs we should be aware of? Examples: allergic to nuts or bees, has asthma, etc...If none, please indicate this.
*

Do you plan to stay with your child? We are more than happy for you to stay with them, whether you participate or not. It is recommended for kids younger than 10, but not required.

Yes

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Do you plan to have someone other than yourself pick up your child(ren)? If you are not sure at this point, you can answer this when dropping off your child).

Parent/Guardian Name *

Parent/Guardian Email *

Parent/Guardian Phone (for emergencies only) *

City or township you live in
*

Submit

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