This document contains a release of claims by you. Please read it carefully.

Group Name: _____________________________________________________________

Proposed Use of Facilities: __________________________________________________

Date(s) of Proposed Use: ____________________________________________________

The above listed group plans to visit Horse Creek Wildlife Sanctuary and Animal Refuge on the date indicated. In consideration of the services and use described above of the facilities of Horse Creek Wildlife Sanctuary and Animal Refuge (HCWSAR) and The Sharon Charitable Trust, its officers, agents, employees, and all other persons or entities associated with this organization, I agree as follows:

Although HCWSAR has taken reasonable steps to provide you with appropriate equipment and facilities so you can enjoy an activity for which you may not be skilled, we wish to remind you that the activities you engage in are not without risk. Certain risks cannot be eliminated without destroying the unique character of the facilities and activities. The same elements that contribute to the unique character of this activity can be cause for loss or damage to equipment or accidental injury, illness, or in extreme cases permanent trauma or death. We do not want to frighten you or reduce your enthusiasm for this activity, but we think it is important for you to know in advance what to expect and to be informed of the inherent risks. The following describes some, but not all of these risks:

Inclement weather, wild and domestic animals, insect bites, stings, sunburn, blisters, cold water, strenuous exercise, cold and hot temperatures, irregular footing, accident or illness in remote places.

I am aware that hiking, canoeing, kayaking, biking, climbing, backcountry travel and all other activities may entail risks of injury or death to the participation. I understand the description of these risks is not complete and that other unknown or unanticipated risks may result in injury or death. I agree to assume responsibility for the risks identified herein and those risks not specifically identified. My child's participation in this activity is purely voluntary, no one is forcing him/her to participate, and I elect to allow said child to participate in spite of the risks.

In order to minimize the risk of injuries to the participant and others I agree that he/she is to abide by all rules and regulations of HCWSAR and to obey any instructions by HCWSAR personnel during use of the facilities. I understand that failure to do either will terminate his/her permission to use the facilities.

The participant possesses at least the following qualifications, which I understand are prerequisites to participate in this activity: There are no medical problems that would preclude said student from this activity and he/she is physically capable of engaging in this activity. I acknowledge that he/she has the degree of skill and knowledge necessary to participate. I certify that said participant is fully capable of participating in this activity. Therefore, I assume full responsibility for the student, for bodily injury, death, loss of personal property and expenses thereof as a result of those inherent risks and dangers and of his/her negligence while participating in this activity.

I have read, understood, and accepted the terms and conditions stated herein and acknowledge that this agreement shall be effective and binding upon myself, my heirs, assigns, personal representatives, and estate for all members of my family.

In the event of an emergency, personnel representing Horse Creek Wildlife Sanctuary and Animal Refuge are authorized to consent to an X-ray examination, medical, dental, or surgical diagnosis, treatment, and hospital care as advised and supervised by a physician, surgeon, or dentist (as appropriate) licensed to practice under the laws of the state where the services are rendered, either at a doctor's office or in any hospital. (It is understood that family members would be contacted as soon as possible should any emergency event occur.)

I understand that HCWSAR reserves the right to take photographic or film records of any activities on its premises, and I hereby agree that HCWSAR may use any such photographic or film records for promotional purposes.

PARENTS OF ALL PARTICIPANTS MUST SIGN THIS FORM AND RETURN IT TO THE SPONSORING GROUP IN ADVANCE OF PARTICIPATION. IT IS THE RESPONSIBILITY OF THE PARTICIPATING GROUP TO PROVIDE COMPLETED FORMS TO HCWSAR IN AVANCE OF THE EVENT.

Participant's Name: ______________________________________________________________

Signature of Parent or Guardian: __________________________________________________