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City of Portage Junior Ranger Club Release of Liability Form
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Junior Ranger Club Release of Liability and Publicity Release Form
Release of Liability
I, the undersigned, consent to participate in the Portage Junior Ranger Club or being the parent or legal guardian of such a participant. In consideration of my or another’s participation in the Junior Ranger Club hereby for myself, and any participant for who I am a parent or legal guardian, release, discharge, waive and hold harmless the City of Portage, its officers, agents, representatives and employees, from and against any and all liability, actions, causes of actions, claims known or unknown now existing or that may arise in the future arising out of or connected in any way from participation in the Junior Ranger Club even though liability may arise out of negligence or carelessness on the part of the persons or entities mentioned above. I also hereby for myself or any participant for who I am a parent or legal guardian, waive, release and discharge any and all claims for damages for death, personal injury or property damage which may subsequently accrue as a result of participation in the Junior Ranger Club. I acknowledge, that the City of Portage, including the City of Portage Parks & Recreation Department, is not to be held responsible for damaged or lost items submitted as participation in the Junior Ranger Club.
I further understand and acknowledge that accidents may occur during an event or activity which may result in personal injuries and/or property damage as a consequence thereof. Knowing the risks involved, I nevertheless, agree to assume those risks and to release and hold harmless all of those persons and entities mentioned above who, through negligence or carelessness, might otherwise be liable to me, or my heirs or assigns, for damages.
It is further understood, the listing and use of video links related to the Jr. Ranger Club, are being used for educational purposes, and the City of Portage is not profiting nor is the creator being infringed upon by our use. The City of Portage, or its employees, is not holding itself out as experts in those fields and are merely providing educational information from YouTube and other sources which is in the public domain.
It is further understood and agreed that this waiver of release is an assumption of risk and is to be binding on my heirs and assigns.
I agree to be fully responsible for any injury or damage to any non-participant who may accompany me and hold the City, its officers, agents, representatives and employees harmless from any liability or actions which may result.
I further agree to abide by and accept all of the rules, conditions and regulations of the City of Portage which are a condition of my participation in this Project.
The City of Portage including the Parks & Recreation Department has my permission to use my or any participant for who I am a parent or legal guardian photo/image, voice or an item created for the Jr. Ranger Club including photos, drawings/illustrations, sculptures or other submitted item for promotional or educational purposes only including exhibition displays. The City of Portage will receive the right to reproduce, at its own expense, images including, but limited to printed materials, online publications, news releases, videos, advertisements, media sites, website and social media outlets. I also provide permission for my name to be used in conjunction with the photos, videos or exhibition items for display, however in the case of a child under 18 years of age, only the first name and last initial will be used. I also understand that no royalty, fee or other compensation shall become payable to me, or any participant for who I am a parent or legal guardian, by reason of such use. I hereby release the City of Portage and its agents and assigns from any and any claims which may arise out of or are in any way connected with such use.
If signing this Release of Liability and Publicity Release form on behalf of a child (under 18 years of age), I certify that I am the parent or guardian of that child listed below.
Name of Participant
Name of Parent or Guardian (if participant is under 18)
Electronic Signature Agreement
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
Electronic Signature of Participant (or parent/guardian if participant is under 18)
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