TO BE COMPLETED BY THE PARENT/GUARDIAN OF THOSE UNDER AGE 18.

LIABILITY RELEASE for Southeastern NaturalSciencesAcademy Outing revised 11/04

I (parent/guardian)___________________________________, have chosen to allow my child, ____________________________, to participate in the following trip, hike, class, club, 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, on behalf of my child, willingly assume all risks associated with his/her participation and I grant this release of liability. I understand and agree on behalf of myself and my child 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 my child while participating in the outing.

On behalf of my child, his/her estate and personal representative thereof, his/her 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 child’s 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. On behalf of my child, his/her estate, and the personal representative thereof, his/her 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 child’s participation on this outing.

IN WITNESS WHEREOF, I have executed this release.

______________________________________

Signature of Parent/Guardian of Participant

______________________________________

Date