INDIVIDUAL Registration & Waiver Form - Earth Day 2016
I HEREBY CERTIFY THAT I AM AWARE OF THE INHERENT HAZARDS OF A BEACH CLEANUP.

I agree as follows: 1. I am volunteering my services for the 2016 Earth Day Beach & Neighborhood cleanups (“the Event”) on a voluntary basis without anticipation of payment of any kind;
2. I will perform assigned tasks that are within my physical capability to the best of my ability, and I will not undertake tasks that are beyond my ability;
3. I will not participate if under the influence of alcohol or any  drug that could impair my physical or mental abilities;
4. I am familiar with the safe operation and use of equipment and tools that I may utilize in connection with this volunteer activity, and I will not undertake to use any equipment or tools with which I am unfamiliar or do not know how to operate safely;
5. I acknowledge that I have received and read appropriate instruction regarding this Event, including appropriate safety and emergency procedures, and that I fully understand those instructions and that I agree, after proper inspection, to use only the supplies, tools and equipment provided by the Event organizers;
6. I will perform only those tasks assigned, observe all safety rules, and use care in the performance of my assignments;
7. I specifically acknowledge that I am engaging in this activity as a volunteer, at my own request and risk,
and not as a State of California or Foundation employee, agent, official, officer or representative, and further acknowledge that I am not entitled to any compensation, benefit or insurance coverage from the State of California, the Department of Parks and Recreation, the California Coastal Commission, the California State Parks Foundation or any Event promoter or sponsor, nor will I make any such claim.

I understand and agree that neither the State of California, California Coastal Commission, California Department of Parks and Recreation, California State Parks Foundation, nor any other organizers or promoters or sponsors or property owners involved in this event, nor any of their respective employees, officers, agents or assigns, (hereinafter collectively referred to as “Released Parties”), may be held liable or responsible in any way for any injury, death or other damages to me or my family, heirs, or assigns that may occur as a result of my participation in this activity, or as a result of product liability or the negligence of any party, including Released Parties, whether passive or active.
I understand that cleaning up beaches and waterfront areas involves certain inherent risks, including but not limited to, the risks of possible injury, infection or loss of life as a result of contact with needles, condoms, metal objects, burning embers or other hazardous materials found on the beach, or from over-exertion or environmental conditions. Despite these risks, I still choose to proceed in such activity.
I know of no physical limitation which should keep me from undertaking the activities associated with this Event. In Consideration for being allowed to participate in this activity, I hereby personally assume all risks in connection with the Event for any harm, injury or damage that may befall me as a participant, including all risks connected therewith, whether foreseen or unforeseen. I further save and hold harmless said activity and Released Parties from any claim or lawsuit for personal injury, property damage, or wrongful death, by me, my family, estate, heirs, or assigns, arising out of participation in this activity, including both claims arising during the activity and after I complete the activity.
If I should become injured while participating in the Event, I authorize any physician or surgeon licensed in the State of California to perform emergency or surgical treatment as in his or her sole judgment may be necessary. I further declare that I am eighteen and legally competent to sign this liability release, or that I have acquired the written consent of my parent or guardian. I understand that the terms herein are contractual and not a mere recital, that this instrument is a legally binding, and that I have signed this document of my own free act.

I agree to allow my image to be used in published materials and web sites that promote the programs of the California Coastal Commission.

BY THIS INSTRUMENT I DO HEREBY EXEMPT AND RELEASE ALL “RELEASED PARTIES,” AS DEFINED ABOVE, FROM ALL LIABILITY OR RESPONSIBILITY WHATSOEVER FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH, HOWEVER CAUSED, INCLUDING NEGLIGENCE OF THE RELEASED PARTIES, WHETHER PASSIVE OR ACTIVE.
I HAVE FULLY INFORMED MYSELF OF THE CONTENTS OF THIS LIABILITY RELEASE AND ASSUMPTION OF RISK
BY READING IT BEFORE I SIGNED IT ON BEHALF OF MYSELF AND MY HEIRS.

IF PARTICIPANT IS UNDER 18, THE PARENT(S) (OR GUARDIAN(S), IF ANY) MUST SIGN.
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First Name *
Last Name *
Email Address *
Street Address *
City *
Zip Code *
Which Earth Day site would you like to join? *
Please pick a cleanup or restoration site (if your site is not listed, list it in "Other" below).
OTHER Earth Day Site
Or give us the name of your street, neigborhood park, community center or creek.
Are you bringing: *
We encourage you to bring your own gloves & buckets - Supplies will be provided if needed.
Required
Would you like to receive an email about our next beach cleanup? *
We will not share or sell your information and we won't spam you, promise!
Are you over 18? *
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