GROUP VOLUNTEER APPLICATION FORM Name or type of group ...

CATALINA ISLAND CONSERVANCYVO LUNTEER RE LEASE O F L IABI L ITY, WAIVER O F CLAIMS, AND INDEMNITYAGREEMENTIn consideration for permitting Volunteer to participate in these, and all subsequentactivities at The Santa Catalina Island Conservancy Volunteer Department ("VolunteerDept."), the parent or legal guardian of this Volunteer hereby assumes all risks involvedin the use of Santa Catalina Island Conservancy ("SCIC") roads and property, andparent/legal guardian and Volunteer for himself/herself, his/her heirs, executors,successors and assigns, hereby waives and releases any and all claims, demands orrights of action, in law or in equity, known or unknown, against SCIC, any and all ownersof the land over which the roads pass ("Owners"), and the officers, directors, members,agents and employees of either, arising from or by reason of any death injury, loss ordamage to Volunteer, regardless of responsibility for negligence, arising out of orresulting from use of said property or roads, unless the same be attributable to thegross negligence or willful misconduct of SCIC, Owners, or the officers, directors,members, agents or employees of either.Parent or legal guardian of Volunteer further agree to indemnify and hold harmlessSCIC, Owners, and any officers, directors, members, agents or employees of either,from any and all losses, claims, liabilities or expenses of whatever kind, regardless ofresponsibility for negligence, arising out of or resulting from the use of the propertyand/or roads of SCIC or Owners, or any activities of or relating to the activities ofVolunteer Dept., whether authorized or not.The undersigned Volunteer's parent or legal guardian has read and understands theWAIVER, RELEASE and INDEMNITY AGREEMENT. Volunteer and his/her parent or legalguardian understand that this WAIVER, RELEASE and INDEMNITY AGREEMENT appliesto these and all subsequent activities of the Volunteer Dept.Parent/legal guardian sign this WAIVER, RELEASE and INDEMNITY AGREEMENT oftheir own free will.Name of Volunteer (Please Print)___________________________Date______________________Name of Parent/Guardian (Please Print)_____________________Phone ____________________Address_________________________________________________E-Mail____________________City, State, Zip________________________________________________Signature of Parent/Guardian _____________________________________By signing this Agreement, I consent to having all photo/video documentationrecorded by SCIC personnel used for educational, media-related, and promotionalpurposes by SCIC.IN CASE OF EMERGENCY, PLEASE CONTACT:Name (Please Print) __________________________________ Relationship to You__________Address ___________________________________________ Telephone (_____)____________City, State, Zip______________________________________Please note any medical conditions (i.e. allergies, diabetes, asthma, heart problems,etc.)__________________________________________________________________________________Please return this form to: