The Junior Keeper Program is for kids ages 9-15
Fill out the information below and select which dates you would like to sign up for! ($50 per program)
* For the safety of the child, anyone picking up the child from the Youth Volunteer Program must be listed on this form and must present Photo ID at time of pick up*
Please read carefully and be certain you understand every aspect of this agreement. Questions or concerns should be rectified PRIOR to beginning the tour.
Inherent Hazards and Risks include, but are not limited to:
- Risk of injury from activity and equipment utilized is significant including the potential for permanent disability and/or death.
- Possible equipment failure and/or malfunction of my own or others’ equipment.
- Outdoor activities include risks associated with exposure to elements, excessive heat, hypothermia, encountering objects either natural or man-made, exposure to animals with the risk of kicking,biting, scratching, or otherwise moving in an unanticipated manner causing injury and/or death.
- My own negligence and/or the negligence of others, including but not limited to error and guide decision-making including misjudging terrain or weather.
- Attack by or encounter with insects, reptiles, wildlife, and/or other plants and/or animals.
- Accidents or illness occurring in remote places where there are no readily available medical facilities.
- Fatigue, chill, and/or dizziness, which may diminish my/our recreation time and increase the risk of accident or injury.
I understand the description of risks is not complete and that unknown or unanticipated risks may result in injury, illness, and/or death.
In consideration for being permitted to participate in the activity(ies) described above and related activity(ies), I hereby agree, acknowledge and appreciate the following:
I HEREBY RELEASE AND HOLD HARMLESS WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER CAUSED BY
NEGLIGENCE OR OTHERWISE, the following named persons or entities, herein referred to as “Releasees”.
PHOENIX HERPETOLOGICAL SOCIETY (PHS), DANIEL MARCHAND – 28011 N. 78TH STREET, SCOTTSDALE, AZ 85266
To release the Releasees, their officers, directors, employees, representatives, agents, and volunteers, and vessels from liability and responsibility whatsoever and for any claims for causes of action that I, my estate, heirs, survivors, executors, or assigns may have for personal injury, property damage, or wrongful death arising from the above activity(ies) whether caused by active or passive negligence or the Releasees or otherwise. By executing this document, I agree to hold the Releasees harmless and indemnify them in conjunction with any injury, disability, death, or loss or damage to person or property that may occur as a result of engaging in the above activity(ies).
By entering into this Agreement, I am not relying on oral or written representation/statements made by Releasees, other than what is set forth in this Agreement.
This release shall be binding to the fullest extent permitted by law. If any provision of this release is found to be unenforceable, the remaining terms shall be enforceable.
I HAVE READ THIS RELEASE OF LIBILITY AND ASSUMPTION OF RISK AGREEMENT, AND I FULLY UNDERSTAND ITS TERMS, AND UNDERSTAND THAT I HAVE RELINQUISHED
LEGAL RIGHTS BY SIGNING THIS AGREEMENT, AND I SIGN IT FREELY AND VOLUNTARILY WITOUT ANY INDUCEMENT.
FOR PARTICIPANTS OF MINORS (under 18 years of age): This is to certify that I, as Parent/Guardian/Temporary Guardian with legal responsibility for this participant, do consent and agree to not only his/her release of all Releasees, but also to release and indemnify to Releasees from any and all liabilities to his/her involvement in these programs for myself, my heirs, assigns, and next-of-kin.
Visa®, MasterCard® & Discover® cardholdersYour security code is the 3-digit code at the end of the signature field on your card's back.
American Express® cardholdersYour security code is the 4-digit code located above the actual credit card number on your card's front.