Pioneers in Conservation Reservation Form

Saturday, September 23, 2023

Distillery Conservation Area
Belvidere, IL 61008

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Family Wagons are intended for families with children under the age of 12. If you don't have young children, please choose the other times.
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PROGRAM PARTICIPATION WAIVER AND RELEASE OF ALL CLAIMS

As a participant in the Pioneers in Conservation program at the Boone County Conservation District, I recognize and acknowledge that there are certain risks of physical injury, and I agree to assume the full risk of any injuries, damages, or loss that I may sustain as a result of participating in any and all activities connected with or associated with my participation, including COVID-19 or any variant thereof. I agree to waive and relinquish all claims I may have as a result of participating in any activities against the Boone County Conservation District and their officers, agents, servants, and employees, from any and all claims from injuries, damages or loss which I may have, or which may accrue to me on account of program activities and agree to indemnify and hold harmless BCCD, its agents, successors, assigns, employees, officers, directors, attorneys, accountants, from any claim whether now known or not known, directly or indirectly arising out of any such injury, damage, or COVID-19 or any variant thereof. In case of emergency, I authorize officials of the Boone County Conservation District to secure from any licensed hospital, physician, and/or medical personnel, including ambulances and personnel, any treatment deemed necessary for my immediate care, and I agree that I will be responsible for the payment of any and all medical services rendered on my behalf. I have read and fully understand the above program details, waiver, and release of all claims and permission to secure support.

PHOTOGRAPHY RELEASE

We (I) the undersigned parent/guardian or participant listed below give permission to photograph the participant of a Boone County Conservation District program on the date(s) listed below. We (I) understand that these photographs will be used for promotional purposes for the Boone County Conservation District in print, media, newspaper, and internet venues.

We (I) understand and agree that neither we (I) or my child/ward will receive financial reimbursement for these photographs and that they are the property of the Boone County conservation District into perpetuity.

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You will receive an email with a unique ID and your name on it. Please print and bring with you when you attend the event.