TO BE COMPLETED BY THOSE AGE 18 AND OVER.

LIABILITY RELEASE for SoutheasternNaturalSciencesAcademy Outing revised 11/04

I, ___________________________________, have chosen to participate in the following event, hike, class, workshop, or outing sponsored by Southeastern Natural Sciences Academy, a nonprofit corporation organized and existing under the laws of Georgia:

Event / Field Trip: ______________________________________________

Event Date: ______________________________________________

Activity in a natural ecosystem such as Phinizy Swamp involves risks which cannot be eliminated by Southeastern Natural Sciences Academy. In consideration for being allowed to participate, I willingly assume all risks associated with my participation and I grant this release of liability. I understand and agree to abide by all instructions, rules and regulations of the leader designated by the Academy regarding safety and the use of all equipment. I also give the Academy permission to use, at their discretion, any photographs taken of me while participating in the outing.

On behalf of myself, my estate and personal representative thereof, my heirs and assigns, I hereby forever release Southeastern Natural Sciences Academy, a nonprofit corporation organized and existing under the laws of Georgia, its officers, directors, employees and agents from any and all costs, claims, losses, liabilities or damages arising from or in any way related to my participation in this outing. I expressly intend this release to be effective with regard to claims of liability asserted in negligence, strict liability, tort, or other theory of recovery. For myself, my estate, and the personal representative thereof, my heirs and assigns, I covenant and agree to make no claim, nor to institute any suit, action or proceeding against the Academy, its officers, directors, employees or agents, relating to any accident, incident or occurrence arising out of or in connection with my participation on this outing.

IN WITNESS WHEREOF, I have executed this release.

______________________________________

Signature of Participant

______________________________________

Date