Cox Jacksonville River Cleanup

Release of Liability and Assumption of Risk – River Cleanup

In consideration of being allowed to participate in any way in the Cox Jacksonville River Cleanup and the related event and activities during the period of November 4, 2017 I the undersigned (Participant), acknowledge, appreciate, and agree that:

1. I am donating my time and services without any compensation and shall at no time be considered an employee or independent contractor of American Rivers for this event. The risk of injury from the activities involved in this program may be significant, including the potential for permanent paralysis and death.

2. I understand that American Rivers, Cox Jacksonville, and St. Johns Riverkeeper (collectively, “Releasees”), do not require me to participate in these activities. I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of the Releasees or others, and assume full responsibility for my participation.

3. I willingly agree to comply with terms and conditions for participation. If I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately

4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, hereby release indemnify, and hold harmless Releasees and their officers, agents and/or employees, other participants, sponsors, advertisers, partners, and, if applicable, owners and lessors of premises used to conduct the event, from any and all claims, demands, losses, and liability arising out of or related to any injury, disability or death I may suffer, or loss or damage to person or property, whether arising from the negligence of the Releasees or otherwise, to the fullest extent permitted by law.

5. Any dispute between American Rivers and me will be governed by the substantive laws of the District of Columbia. Any action or proceeding arising hereunder shall be brought in the courts of the District of Columbia.

6. I hereby acknowledge that I have been advised to consult a physician before engaging in such activities. In the event of an emergency, I authorize Releasees’ employees or agents to secure from any licensed hospital, physician or medical personnel any treatment deemed necessary for my immediate care. I agree that I will be responsible for payment of any and all medical services rendered.

7. I grant to Releasees and their employees or agents the right to take photographs at this cleanup of me and of any minor participants for which I am the parent or guardian. I authorize American Rivers, its assigns and transferees to use such photographs, with or without names, for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content, and to copyright, use and publish the same in print and/or electronically.

I have read this release of liability and assumption of risk agreement, fully understand its terms, understand that I have given up substantial rights by signing it, and sign it freely and voluntarily without any inducement.

City, State of Volunteer Activity: Jacksonville, FL

Dated: April 25, 2024

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Adult Minor(s)
1 Minor 2 Minors 3 Minors 4 Minors 5 Minors More Minors 6 Minors 7 Minors 8 Minors 9 Minors 10 Minors

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First Participant's Name

First Name*

Last Name*

Phone*

First Participant's Date of Birth*

First Participant's Signature*

Second Participant's Name

First Name*

Last Name*

Second Participant's Date of Birth*

Third Participant's Name

First Name*

Last Name*

Third Participant's Date of Birth*

Fourth Participant's Name

First Name*

Last Name*

Fourth Participant's Date of Birth*

Fifth Participant's Name

First Name*

Last Name*

Fifth Participant's Date of Birth*

Sixth Participant's Name

First Name*

Last Name*

Sixth Participant's Date of Birth*

Seventh Participant's Name

First Name*

Last Name*

Seventh Participant's Date of Birth*

Eighth Participant's Name

First Name*

Last Name*

Eighth Participant's Date of Birth*

Ninth Participant's Name

First Name*

Last Name*

Ninth Participant's Date of Birth*

Tenth Participant's Name

First Name*

Last Name*

Tenth Participant's Date of Birth*

11 Participant's Name

First Name*

Last Name*

11 Participant's Date of Birth*

Participant's Address

Address Line 1:*

Street address, P.O. box, company name, c/o

Address Line 2:

Apartment, suite, unit, building, floor, etc.

Country:*

City:*

State/Province:*

Zip/Postal:*

Parent / Guardian's Email Address

Email*

Confirm Email*

American Rivers can contact me regarding this event, National River Cleanup, or American Rivers’ events.

Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*

FOR PARENTS/GUARDIAN OF PARTICIPANT OF MINOR AGE (UNDER AGE 18 AT TIME OF REGISTRATION) This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liability incidents to my minor child’s involvement or participation in these programs as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by law.

Parent / Guardian's Name

First Name*

Last Name*

Phone*

Parent / Guardian's Date of Birth*

Parent / Guardian's Signature

Electronic Signature Consent*

By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.

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