Liability Waiver for Wilderness Defender Field Outings

Event (please check):*

Wilderness Defender Outing

Outing Location:*

Emergency Contact Name:*

Emergency Contact Phone Number:

(###)###-####

ELECTRONIC SIGNATURE (Please type your first & last name)*

Signature Confirmation*

By signing above, I confirm that I have read and understand this document in its entirety. I voluntarily agree to assume the risks of participating in this Activity and to waive any claim I may have against the New Mexico Wilderness Alliance or its employees, directors, or agents as a result of Injuries or Damages I may experience during my participation in the Activity.

Date*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone number

Photo Consent*

I grant the New Mexico Wilderness Alliance the right to take photographs of me and my family in connection with the Activity, and to use and publish the photographs, with or without my name, for any lawful purpose, including in digital or print media.

I consent to the photo policy above.
I do not consent to the photo policy above.

* The following section must be completed if you are a minor (under age 18). Your parent or legal guardian must sign this Agreement below on your behalf.*

I hereby agree and consent to the foregoing Agreement on behalf of:

First Last

Name of minor

Age of minor

ELECTRONIC SIGNATURE of Parent or Guardian (Please type your first & last name)

Signature Confirmation

On behalf of the above-named Minor, I voluntarily agree to assume the risks of the Minor’s participation in this Activity and to waive any claim the Minor may have against the New Mexico Wilderness Alliance or its employees, directors, or agents as a result of Injuries or Damages the Minor may experience during the Minor's participation in the Activity.

*** The following section must be completed if you are a minor (under age 18). Your parent or legal guardian must sign this Agreement below on your behalf.***

* The following section must be completed if you are a minor (under age 18). Your parent or legal guardian must sign this Agreement below on your behalf.*