January Leach Back 5 Waiver

Please read these options carefully and select the option that best describes you and your group.
**REMINDER: please fill out a separate form for each person who is attending, including minors.**

I am OVER 18 and attending alone.I am UNDER 18 or completing this form for someone under 18.There are others coming with me, that are OVER 18. I will complete this waiver for myself and invite them to sign this wavier by copying and pasting the URL for this form.There are others coming with me that are UNDER 18 and will be under my supervision. I will fill complete this waiver for myself and complete a separate from for each individual who is attending.

If you are under 18 and planning to come without a parent/guardian, you can't sign this form. Please have your parent/guardian sign for you, and make sure to have their phone number included in the box above. Our team will reach out to your parent/guardian to verify that they have given their permission for you to attend without them.

This is OK with me. I will have my parent/guardian sign.This is not OK with me. I will not attend the event.

Participant Contact Details

First Name

Last Name

Mobile Phone

Participant Email

Participant Address

Mailing Address

City

State

Zip Code

Disclaimer: Your address will never be shared outside this organization. It will only be used for direct communication with JCWC. You may be included in appeals to financially support the organization.

Parent or Guardian Contact Details

First Name

Last Name

Parent or Guardian Mobile Phone

Parent or Guardian Email

Age of Participant

How did you hear about this event?

Other

Please note: Oregon Health Authority may use your information to contact you if someone who attends this event tests positive for COVID-19.

My name below acknowledges that I have read this waiver and hereby agree:

In connection with my voluntary involvement in activities undertaken for, and with the participation and support of the Johnson Creek Watershed Council, a non-profit organization, the City of Portland, I hereby agree, for myself, my heirs, assigns, executors, and administrators to release and discharge the Johnson Creek Watershed Council, the City of Portland, other project sponsors, their members, officers and directors, employees, agents, volunteers, sponsors and landowners from all claims, demands, and actions for injuries sustained to my person and/or property as a result of my involvement in such activities, whether or not resulting from negligence, and I agree to release and hold the Johnson Creek Watershed Council, the City of Portland, other project sponsors, their officers and directors, employees, agents volunteers, sponsors and landowners harmless from any cause of action, claim, or suit arising there from. I hereby attest that my attendance and involvement in such activities is voluntary, that I am participating at my own risk, and that I have read the foregoing terms and conditions of this release.
I hereby grant Johnson Creek Watershed Council, and the City of Portland, the irrevocable right to use forever any film, video tape, audio tape, photographs, slides, or combination thereof, for inclusion in any promotional or advertising purposes and I agree to appear without pay. If I do not want to be photographed, I will inform staff and they will try to accommodate my wishes.
I hereby agree to use good judgment based on my physical ability and to immediately terminate my participation in the project if activities become too strenuous or difficult; I am physically and mentally fit and able to participate in this project.

By checking this box I agree to receive emails from JCWC.

I agree

Checking the box and typing my name below acknowledges that I have read this waiver and hereby agree.

I agree.

Participant Waiver Signature (type full name)

Parent or Guardian Waiver Signature (type full name)

Contact Information