Name *

First Name

Last Name

Phone *

(###)

###

####

Desired Date *

Saturdays preferred.

MM

DD

YYYY

Agreement to LNC Policies *

I hereby authorize the Louisville Nature Center (LNC) to take any steps to ensure my child’s health and safety in case of an emergency. In consideration of the LNC allowing my child to participate in this educational program, I, for myself and my child, hereby waive and release the LNC, its officers, agents and employees, from any and all claims or causes of actions for injury, damage or loss to the person or property of my child while participating in this program. I further hereby agree to indemnify, hold harmless and defend the LNC, its officers, agents and employees, from any and all losses, claims, or causes of action for injury, damage or loss in any way relating to or arising from any incidence arising out of my child’s participation in the program. This waiver and release is intended to be an express waiver of and release from any and all claims against the LNC, its officers, agents and employees arising from my child’s participation in the program, including all claims or causes of action based upon the alleged negligence or gross negligence of the LNC, its agents, officers or employees. LNC reserves the right to change or cancel parties based on current recommendations from the CDC and/or state and local government.

I have read and agree to the above policies.