Virtual Hike Habit Registration

Emergency Information

Multi-media Consent Agreement

**We will not be recording or taking photographs during this Virtual Hike, but we do welcome participants to take photographs on their individual walk and send them to us to share with the community**

I, the undersigned, do hereby grant permission to Wild Grief, a Washington State non-profit corporation, for me or for my minor child to be interviewed, photographed and/or videographed during any program-related activities and events. My or my child’s image, video, interview or quote may be published on their website(s), online and print publications, and other multi-media venues as deemed necessary and appropriate.

I hereby release any of the above organization, their representatives, employees, volunteers, officers, directors, and subsidiaries, from all claims and demands arising out of or in connection with any use of said “materials”, including, without limitation, all claims for invasion of privacy, infringement of my right to publicity, defamation and any other personal and/or property rights.

It is further agreed that above entities may use such material for promotional and fundraising
purposes. This may include, but is not limited to, visual displays, website, publications, videos,
and/or news media coverage.

I acknowledge and agree no sums whatsoever will be due to me or my child as a result of the use of the “materials” and acknowledge that I have received no monetary compensation for “materials” used pursuant to this release.

Acknowledgement of Participant Responsibility, Express Assumption of Risk, and Release of Liability.

A Wild Grief Virtual Hike consists of a group videoconference with other participants who are experiencing grief before and after an unsupervised hike you conduct on your own. There are risks to your safety from these activities including but not limited to the possibility of discomfort discussing past experiences or injury from walking.

To the fullest extent allowed by law, I agree to WAIVE, DISCHARGE CLAIMS, AND RELEASE FROM LIABILITY Wild Grief, a non-profit Washington State corporation, its officers, directors, employees, agents, leaders and volunteers from any and all liability on account of, or in any way resulting from Injuries and Damages, even if caused by negligence of the Wild Grief its officers, directors, employees, agents, leaders and volunteers in any way connected with this Virtual Hike which will include a videoconference group discussion before and after the hike.  I further agree to HOLD HARMLESS Wild Grief, its officers, directors, employees, agents, and leaders from any claims, damages, injuries or losses caused by my own negligence while a participant on the outing and discussions. I understand and intend that this assumption of risk and release is binding upon my heirs, executors, administrators and assigns, and includes any minors accompanying me on the Virtual Hike.
 
I have read this document in its entirety and I freely and voluntarily assume all risks of such Injuries and Damages and notwithstanding such risks, I agree to participate in the Hike.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

If you are a minor (under age 18), your parent or legal guardian must sign this Agreement on your behalf.

I am the legal parent/guardian of the above-named participant who is under eighteen years of age, and I am fully competent to sign this form. I hereby agree and consent to the foregoing Agreement on behalf of the minor above.