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I fully accept and assume all risk and responsibility as a result of the child(ren)s participation. I hereby release, waive, discharge and covenant not to sue PUDDLESTOMPERS™ Nature Exploration Inc. (henceforth referred to as PUDDLESTOMPERS™) , its owners, officers, instructors, employees, contractors and agents (“Releasees”) from any and all liability, claims, demands or causes of actions whatsoever, including but not limited to claims for personal injury, harm, death, loss, damage and/or damage to personal property that may occur while participating in PUDDLESTOMPERS™ programs and/or while on any premises where PUDDLESTOMPERS™ is running activities, classes and/or camps.

Covid-19 *

PUDDLESTOMPERS™ is taking preventative measures to decrease the spread of COVID-19 and is following mandated guidelines issued by the state of Massachusetts; however PUDDLESTOMPERS™ cannot guarantee that you or your child(ren) will not become infected with COVID-19 during participation in our programs. Attending PUDDLESTOMPERS™ drop-off programs could increase the chance of you or your child(ren) contracting COVID-19.

By checking this box, I acknowledge that participation in PUDDLESTOMPERS™ programs could result in injury to program participants and/or their exposure to illness and/or communicable diseases, including but not limited to COVID-19. I understand the risks of becoming exposed to or infected by COVID-19 at PUDDLESTOMPERS™ may result from the actions, omissions, or negligence of myself and others, including, but not limited to PUDDLESTOMPERS™ employees, and program participants and their families.

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I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to disability, personal injury, and death), illness, loss, claim, damage, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at any PUDDLESTOMPERS™ program (“Claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless PUDDLESTOMPERS™ its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind emerging out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of PUDDLESTOMPERS™, its employees, agents, representatives, and program participants and their families whether a COVID-19 infection happens before, during, or after participation in any PUDDELSTOMPERS™ program.

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By checking this box, you are electronically signing to all terms stated above.

Name of Parent/Legal Guardian *

First Name

Last Name

Name of PUDDLESTOMPERS'™ Participant *

First Name

Last Name

Today's Date *

MM

DD

YYYY

Name *

First Name

Last Name

Parent's/Legal Guardian's Name *

First Name

Last Name

Child's Name *

First Name

Last Name

*

I, parent or legal guardian of the child listed above, give consent for my child to attend PUDDLESTOMPERS Nature Exploration Drop-off Programs.

Emergency Medical Consent *

I hereby authorize the PUDDLESTOMPERS™ Nature Exploration Inc. (henceforth referred to as PUDDLESTOMPERS™) staff or other appropriate personnel to provide first aid, emergency medical care, or if necessary, admission to an accredited hospital, when such care is necessary for the treatment of any injuries, allergic reactions or illness my child may sustain while participating in any activity associated with PUDDLESTOMPERS™

Emergency Contact Name *

First Name

Last Name

Emergency Contact Phone Number *

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Parent's/Legal Guardian's Name *

First Name

Last Name

Child's Name *

First Name

Last Name

*

I, parent or legal guardian of the child listed above, give consent for my child to attend PUDDLESTOMPERS Nature Exploration Drop-off Programs.

Emergency Medical Consent *

hereby authorize the PUDDLESTOMPERS™ Nature Exploration Inc. (henceforth referred to as PUDDLESTOMPERS™) staff or other appropriate personnel to provide first aid, emergency medical care, or if necessary, admission to an accredited hospital, when such care is necessary for the treatment of any injuries, allergic reactions or illness my child may sustain while participating in any activity associated with PUDDLESTOMPERS™

Emergency Contact Name *

First Name

Last Name

Emergency Contact Phone Number *

(###)

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Secondary Emergency Contact Name *

First Name

Last Name

Secondary Emergency Contact Number *

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