Registration for Group Visit

REGISTRATION FOR GROUP VISIT (To download and print this form, click here.)




Individual Registration for Group Visits








    Participant's First Name
        *
    
    
    
    


    Participant's Last Name
        *
    
    
    
    


    Parent's or Gardian's First Name
        *
    
    
    
    


    Parent's or Gardian's Last Name
        
    
    
    
    


    Parent's or Gardian's Phone #
        *
    
    
    
    


    Parent's or Gardian's Email Address
        *
    
    
    
    


    Agreement & Acknowledgement
        *
    
    					
			 I am fully aware, understand and acknowledge that my child will be involved in physical activities during their visit to ACLT, including but not limited to gardening, hiking on nature trails, outdoor games, playground activities, etc., that may result in physical injury. I understand and acknowledge that these activities have inherent risks associated with them, and I knowingly assume those risks, release and covenant not to sue the American Chestnut Land Trust (ACLT) or any personnel or volunteers for any liability whatsoever resulting from my child’s participation in the activities while visiting ACLT.

    
    


    Release of Liability
        *
    
    					
			 In consideration of ACLT’s grant of permission for my child to participate in a group visit, I hereby release and discharge, as well as indemnify and hold harmless, the American Chestnut Land Trust (ACLT), its agents, employees and volunteers, from all claims, demands, actions, judgments, and executions which the undersigned as parents/guardians of the child(ren), ever had or now has or may have or claim to have against ACLT, its successors or assigns, for all personal injuries, known or unknown, and injuries to property, real or personal, caused by, or arising out of the child(ren)’s visit to ACLT.

    
    


    Permission to Use Photographs
        
    
    					
					 I grant the American Chestnut Land Trust (ACLT) permission to use any photographs of my child taken during the visit for promotional purposes.
					
					 I DO NOT grant the American Chestnut Land Trust (ACLT) permission to use any photographs of my child taken during the visit for promotional purposes.

    
    


    Acceptance of Electronic Signature
        *
    
    					
			 By checking here and entering my full name below, I hereby acknowledge and accept that this shall serve as my original signature and shall be legally binding as if signed by me in person.

    
    


    Parent's or Gardian's Electronic Signature
        *
    
    
    
    


    Date
To download and print this form, click here.