Waiver & Release FORM
Indigo Acres 

P.O. Box 146
Bangor, PA 18013
(610)588-8821

 REGARDS:
East Coast Tracking Club___________________________________________________________________________ 
Date Arrive
______________________________ 		 Date Depart
__________________________________________ 
Name (Last, First, Middle Initial)
___________________________________________________________________________ 		 Nickname
___________________________________________ 
Home Address (Number, Street)
_______________________________________________________________________________________________________________________ 
City
__________________________________________ 		 State/Province
______________________________ 		 Zip
____________________ 		 Country
____________________ 
Date of Birth
__________________________________________ 		 Age
______________________________ 		 Home Phone
____________________ 		 Business Phone
____________________ 
___ Male
___ Female 		 ___ Single
___ Married 
Occupation/Employer
_______________________________________________________________________________________________________________________ 
Emergency Contact
__________________________________________ 		 Phone
______________________________ 		 Relationship
__________________________________________ 
How did you learn about Indigo Acres?
__________________________________________ 		 Health/Special Diet Information
___________________________________________________________________________ 
Waiver and Release
Participants In all demonstrations and participations at Indigo's Farm (hereafter known as Indigo Acres), and Loretta Indigo., individually, reasonable care is taken to prevent serious injuries and to minimize accidents. The PARTICIPANT states that he/she is fully aware that survival, tracking, awareness, and philosophy participation, even under the safest conditions possible may be dangerous, and the PARTICIPANT hereby agrees to accept full responsibility and assume all risks, including those caused by acts of God, injury, death, and/or loss to his/her person and/or property knowingly and voluntarily. The PARTICIPANT agrees to obey the rules and regulations that INDIGO ACRES puts into effect to minimize these risks. The PARTICIPANT knowingly, voluntarily, and irrevocably waives any and all past, present, and/or future injuries, death, or loss, including those caused by acts of God, received while participating in activities conducted at INDIGO ACRES as a  participant, spectator, and/or visitor, or in any other manner or form, taking part in the exercises, practices, excursions, and/or demonstrations of said survival, tracking, awareness, and philosophy participation. The PARTICIPANT  certifies that he/she is physically capable to participate in the said survival, tracking, awareness, and philosophy participation activities despite the rigors and dangers inherent in such undertaking. The PARTICIPANT accepts all responsibility for any injury, death, and/or loss to his/her person and/or property, including by acts of God, for the rigors and dangers inherent in this undertaking.  The PARTICIPANT releases  to  INDIGO ACRES rights to use any photograph or video taken while participating in said survival, tracking, awareness, and philosophy participation, to be used as deemed by INDIGO ACRES, including advertising. All children below the age of 18 MUST be accompanied by a legal guardian. There will be no drugs or alcohol permitted on the property. Smoking must be in designated areas only...out and away from the buildings. My signature below indicates my acceptance of these terms and my desire to participate at Indigo Acres and or The East Coast Tracking Club.
Signature of Participant

__________________________________________________________________ 

 Date

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