*1.First name:(Required.)

*2.Last name:(Required.)

*3.Cell number or best number to reach you at on the day of the hike:(Required.)

*4.Email:(Required.)

*5.First and last name of emergency contact: (Required.)

*6.Phone number for emergency contact:(Required.)

*7.Spring 2021 GROTON TRAVERSE: PARTICIPANT WAIVER, RELEASE & INDEMNIFICATION AGREEMENT

Organization Name: Groton Conservation Trust and its Trustees

Please read this waiver and enter your electronic signature and date below.

In consideration of being allowed to participate in this hike and related events and activities, I the undersigned, acknowledge and agree that:

The risk of injury from the activities involved in this program is significant, including the potential for permanent injuries or death.

I am fully aware of the risks and agree to assume full responsibility for any injuries to myself or any minor child as a result of my participation in the activity.

I agree to use reasonable care and to take prudent action to protect myself and any minor child who accompanies me during this activity. If I observe any condition or event that I consider to constitute a hazard or danger during my participation in the activity, I will remove myself from participation and promptly bring the matter to the attention of any representative of the Organization who is present, and if none are present, I agree to contact the Groton Police using a mobile phone to alert them to any hazardous or dangerous condition.

In consideration for participation in the Spring 2021 Groton Traverse event, I hereby for myself, my heirs, personal representatives, executors and administrators waive and release the Groton Conservation Trust and its Trustees and all of its employees, volunteers, officers, directors, contractors and other agents or representatives and their successors and assigns (“the Fully Released Parties”) from any and all actions, causes of action and claims on account of or in any way growing out of, directly, or indirectly, all known and unknown personal injuries, including but not limited to personal injury, property damage and death suffered by my child or myself while participating in this activity. I further agree, on behalf of myself and my heirs, administrators and assigns to indemnify, defend and hold harmless the Fully Released Parties in the event that any claim or cause of action of any type whatsoever is asserted against any one or more of the Fully Released Parties on account of or arising out of any harm, damage, injury or death resulting from any participation in the above-described program by my child or myself, said indemnification to cover both the costs of defense and any sum any sum of money that any Fully Release Party may be compelled to pay.

I have read this Participant Waiver, Release and Indemnification Agreement, fully understand its terms, understand that I have given up substantial rights by signing it and sign it freely and voluntarily on behalf of myself and any minor child. This document is executed under seal.



(Required.)

I HAVE READ AND UNDERSTAND THIS PARTICIPANT WAIVER, RELEASE & INDEMNIFICATION AGREEMENT

*8.Your electronic signature acknowledges your acceptance of this participant waiver, release and indemnification agreement. Please enter your full name here for your electronic signature:(Required.)

*9.Date:(Required.)

10.Name/s of any minor child or children participating: