2023-2024 NatureBridge Participant Registration Form

Attending Group

Please complete this form and provide all requested information. 

If the Participant is a minor, the form must be completed by a parent or legal guardian.   

* indicates required field. 


I am...


Note: Parent/guardian chaperones must complete a form for themselves and a separate form for the attending youth Participant. 
Name and Email of Parent/Guardian Completing Form 



A copy of your responses will be emailed to the email address provided.
Participant Information



A copy of your responses will be emailed to the email address provided




Grade when attending NatureBridge program

Grade when attending NatureBridge program.
Demographic information will only be used for the purpose of supporting the Participant on a NatureBridge program. As an organization, we are committed to equity, inclusion and diversity. By collecting this data, it furthers our goal of ensuring students and staff reflect the demographics of the regions we serve.



Emergency Contact Information
A parent or legal guardian must be provided as the first emergency contact for youth participants.











Health Information

 Health information will only be used for the purpose of supporting the Participant on a NatureBridge program. 

 NatureBridge staff may contact Participant/Parent/Legal Guardian with questions regarding medical or dietary matters in advance of the program.

 If Participant has a medical or dietary need that require a more detailed explanation, you will have an opportunity upload a file below.

Medical Information

Does the Participant have, or has the Participant had, any of the following? 

















Please reach out to your group coordinator if additional information is necessary.
Communicable Disease History
Does the participant have or has the participant had any of the following diseases?





Please reach out to your group coordinator if additional information is necessary.
Food Allergies and Dietary Requests




Please reach out to your group coordinator if additional information is necessary.
Other Allergy Information

Does the Participant have allergies to any of the following?




Please reach out to your group coordinator if additional information is necessary.


Please reach out to your group coordinator if additional information is necessary.


Indicate "Yes" if Participant has other allergies that have not already been indicated in this section or the "Food Allergies and Dietary Requests" section of this form.

Please reach out to your group coordinator if additional information is necessary.
Medication



Please reach out to your group coordinator if additional information is necessary.
Physical, Mental or Cognitive Limitations and Restrictions 
NatureBridge programs are designed to take care of participants in an all-encompassing overnight experience. For some participants, having a change in their typical routine can be challenging. If there are any physical, mental health, cognitive, or neurodivergance that this participant experiences please note them below so that the NatureBridge staff can work towards creating an inclusive experience that honors the various abilities of all participants. Please describe any disabilities or restrictions indicated above and include any suggestions for working to support the participant in their time at NatureBridge.


Please reach out to your group coordinator if additional information is necessary.
Insurance Information (Optional)
Physician signature not required.


Please reach out to your group coordinator if additional information is necessary.


Please reach out to your group coordinator if additional information is necessary.


Please reach out to your group coordinator if additional information is necessary.




Please reach out to your group coordinator if additional information is necessary.

PARTICIPANT AGREEMENT

(INCLUDING ASSUMPTION OF RISKS, RELEASE AND INDEMNIFICATION)


REQUIRED FOR ALL PARTICIPANTS


PLEASE READ THIS ENTIRE AGREEMENT CAREFULLY. IT AFFECTS THE LEGAL RIGHTS OF PARTICIPANTS AND THEIR FAMILIES IN THE EVENT OF AN INJURY OR OTHER LOSS.

All Participants age 18 and older, including all teachers and chaperones, (referred to as “Adult Participants”), must sign this Participant Agreement. At least one parent or legal guardian (both referred to as “Parent”) must sign on behalf of themselves individually as well as on behalf of their minor child or ward (referred to as “Minor Participant”). The term “I” as used in this Participant Agreement refers to the Adult Participant and/or Parent. The term “Program” refers to the NatureBridge program in which a Participant has enrolled. In consideration of the Program, services, benefits and amenities provided by NatureBridge, a California Non-Profit Public Benefit Corporation, I hereby understand, acknowledge and agree as follows:

Activities and Risks


Activities vary from program to program, and may include hiking, stewardship activities (for example, plant removal and trail maintenance), backpacking, skiing, snowshoeing, snorkeling, kayaking, canoeing, other water craft excursions, camping in tents, stays in cabins or other lodging facilities, and staying one or more nights at a remote site away from camp. Some programs involve travel in NatureBridge vehicles driven by NatureBridge employees. I understand that the Program exposes Participants to a variety of risks and hazards, foreseen and unforeseen, some of which are inherent and cannot be eliminated without fundamentally altering the unique character of the Program. These inherent risks include, but are not limited to, environmental risks and hazards, including rapidly moving, deep, or cold water; plants; insect stings and bites; animals, including snakes and predators; falling and rolling rock; lightning; tree and tree limb fall; exposure to allergens, including food allergens; accidents resulting from river crossings, fordings, travel (including travel to or from the program); equipment failure; problems arising from a Participant's loss of balance or inability to follow directions; and unpredictable forces of nature, including weather that may change to extreme conditions without notice. Possible injuries and illnesses include allergic reactions, including, anaphylaxis; hypothermia; frostbite; high altitude illnesses; sunburn, heatstroke, and dehydration; infectious diseases such as Lyme disease, norovirus, plague or hantavirus; musculoskeletal injuries; and other possible serious conditions or injuries, including death. Emergency evacuation and medical care may be delayed twenty-four (24) hours or more due to the remote locations of some Program activities.

SARS-CoV-2 / Coronavirus / COVID-19 Assumption of the Risks and Release


NatureBridge has developed policies for operations based on state, county and CDC guidelines. However, COVID-19 is an extremely contagious disease that spreads easily through person-to-person contact. COVID-19 can lead to severe illness, personal injury, permanent disability and death. COVID-19 can be fatal to older people and people of any age with underlying health issues. In rare instances, children might contract “multi-system inflammatory syndrome in children (MIS-C)” due to potential COVID-19 exposure; while rare, this can cause serious illness or death in children. In addition, there is much we still don’t know about the novel coronavirus. Participating in NatureBridge programs or accessing NatureBridge facilities could increase the risk of contracting COVID-19. While we are taking precautions and following national and state guidelines to limit the spread of coronavirus, NatureBridge cannot warrant that COVID-19 infection will not occur through participation in NatureBridge programs or accessing NatureBridge facilities.


Assumption of the Risks


I understand that the description of the risks involved in NatureBridge activities set forth above is not complete, and that other risks may result in property loss, personal injury, or death. On behalf of myself and my Minor Participant (if applicable), I agree to assume, to the fullest extent permitted by law, all risks of participation in the Program, whether known or unknown, and whether or not such risks are described above. I understand that participation in the Program is entirely voluntary, and I consent to participation with full knowledge of the possible risks of such participation. If the Participant is a minor child, I have discussed the Program activities and risks with them, and confirm that the child wishes to participate in the Program. I confirm that I, and my Minor Participant (if applicable) is/are physically and mentally capable of participating in all Program activities. 


Release and Indemnification


I, an Adult Participant or Parent of a Minor Participant, for myself and on behalf of such Minor Participant, agree to release, indemnify, protect, and hold harmless, and promise not to sue, NatureBridge and/or any of its officers, directors, employees, agents, contractors, and insurers (the “Released Parties”), to the maximum extent permitted by law, with respect to any and all claims, demands, damages, attorneys’ fees, litigation costs, losses, or liabilities, including, but not limited to, claims for property loss, personal injury and/or wrongful death, which I or my Minor Participant may suffer, arising out of or in any way related to my, or my Minor Participant’s, participation in the Program. The claims hereby released and indemnified against include those caused by or arising from the negligence of a Released Party, or any of them, but not those caused by their gross negligence or willful misconduct. 


Medical Authorization


I represent that the medical information I have provided above is current, accurate and complete. I authorize NatureBridge staff to administer first aid, including, where permitted by applicable law, the administration of epinephrine by auto-injector, as well as the administration of “over the counter” medications, including aspirin, Tylenol, ibuprofen, Benadryl, Neosporin, Imodium, laxatives and similar medications. In the absence of school or program chaperones, I authorize NatureBridge staff to administer prescription medications contained in labeled packaging with a medical provider’s prescription. If my Minor Participant has a known life-threatening allergy, or if I have been advised by a health-care provider that the Minor Participant should be prepared for a possible serious allergic reaction, my Minor Participant has been provided with auto-injectable epinephrine and has been instructed by a physician as to its use; in addition, I have instructed my Minor Participant to have the auto-injectable epinephrine on their person and available at all times during the Program. If my Minor Participant is enrolling in the Program as part of a school or other group, I have also informed the person in charge of the school or other group of this allergy and any applicable physician -prescribed protective measures. I confirm that I have, or my Minor Participant has, the ability to hike up to 5 miles per day with up to a 2,000 feet elevation gain without presenting a risk of harm to myself, my Minor Participant, and/or others. I authorize any adult chaperone or member of NatureBridge staff to obtain medical care for my Minor Participant (or for me, if I am unable to consent), and hereby consent to any X-ray, examination, anesthetic, diagnosis, treatment and/or hospital care that may be recommended by a licensed physician and/or dentist. In the event of minor illnesses or injuries, I understand that NatureBridge will attempt to contact me at the earliest practicable opportunity. In the event of a major illness or injury, I understand that NatureBridge will attempt to contact me before the commencement of any medical treatment, unless my Minor Participant’s condition is such that treatment must be commenced immediately before contact with me can be made. If I cannot be reached, this authorization remains in full force and effect.

I agree to assume full financial responsibility for the costs of any early departure, back-country evacuation, and/or medical care or treatment that I or my Minor Participant may receive (including transportation to and from the Program). This includes picking up my Minor Participant due to illness. I understand that NatureBridge may find it necessary to terminate the Program or an activity within the Program, whether due to forces of nature, medical necessity, problems in the group or other reasons that NatureBridge, in its sole discretion, deems prudent, and agree that it may do so. I understand that NatureBridge reserves the right to refuse participation to any person who NatureBridge determines, in its sole discretion, may present a risk of harm to themselves or others, and agree that it may do so.


Other Provisions


I understand that during part of the Program, my Minor Participant will be under the supervision of teachers, chaperones, and other adults who are not NatureBridge employees, and who have not been selected, and are not supervised, by NatureBridge. I understand and agree that NatureBridge is not responsible for the actions of any such individuals.


NatureBridge uses independent contractors for some services, and such independent contractors, and not NatureBridge, are solely responsible for any losses or injuries caused by their acts or omissions. I understand that this Participant Agreement is intended by NatureBridge to have as broad an effect as the law permits, and that if any part of this Participant Agreement is found to be invalid for any reason, the remainder of the Participant Agreement shall remain valid and fully enforceable.


I agree that if there is a dispute between me or my Minor Participant, on the one hand, and a Released Party, on the other, such dispute will be governed by the substantive laws of the State of California, and that any lawsuit against any of the Released Parties will be filed and maintained in a court of competent jurisdiction in San Francisco County, California.


I have been advised to consult with an attorney of my choosing if I have any questions concerning the provisions and/or translation of this Participant Agreement. I certify that I have carefully read this Participant Agreement, I understand its terms, and am signing it voluntarily. I have had any questions concerning the Program answered to my satisfaction.


I understand that in the event of any dispute or issue regarding any translation of this Participant Agreement, the English version of this Participant Agreement shall control.


Photo Release


I agree that NatureBridge and/or its designees may use, without restriction or compensation, my likeness, and/or that of my Minor Participant, whether in photographs or video, as well as any writing, artwork and/or testimonials created by me or my Minor Participant and submitted to NatureBridge. NatureBridge may also conduct educational surveys involving myself or my Minor Participant and share these surveys with partner research organizations. I agree that once submitted, these materials shall become the property of NatureBridge and may be used for marketing or educational evaluation purposes.


optional

By electronically typing my signature, I agree that it has the same legal effect as my handwritten signature.  My electronic signature applies to all pages and terms of this participant registration form.
A copy of your responses will be emailed to the email address provided.  You can also click the printer below to print your form before submitting.
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