Name of Participant * First Name Last Name Phone (###) ### #### Email Name of Parent/Guardian (If Participant is Under 18) First Name Last Name Other Participants in Group List all First and Last Names of group members separated by commas. Event/Program (Check One): * Mobile Micro Farm Farm Visit Volunteering Therapy Session Internship Other Date of Visit MM DD YYYY Time Hour Minute Second AM PM Location * Simple Sparrow Care Farm The Bird House Other If Other, Please Specify Acknowledgment * Animals can be unpredictable. Please do not handle animals without proper training or assistance. By your participation in the program you have indicated that you accept the limits of liability from inherent risks of animal behaviors. I understand and acknowledge that an agritourism entity is not liable for any injury to or death of an agritourism participant resulting from agritourism activities. I understand that I have accepted all risk of injury, death, property damage, and other loss that may result from agritourism activities. I understand Signature of Participant/Guardian * If Under 18, Parent/Guardian's Signature Required Today's Date * MM DD YYYY Thank you for completing the form. General Liability Waiver
