Participant Information First Name * Last Name * Email * Parent or Guardian (click to expand, required if participant is a minor) First Name Last Name Email Minor's Birth Date MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Year2006200720082009201020112012201320142015201620172018201920202021202220232024 Year Liability Waiver (required) Agreement I understand that during my participation in Planting Justice activities, I may be exposed to a variety of hazards and risks, which are inherent in farming-related programs, and cannot be eliminated without destroying the purpose and function of the farm. The inherent risks include danger of personal injury and property damage through natural causes or the actions of other persons, as a result of negligence or otherwise. I also understand and appreciate that I may have to exercise extra care for my own person and for others around me. I further understand that there is nomedical staff on site at the site, and no one from Planting Justice can guarantee my safety. To the best of my knowledge, I am in good physical condition and fully able to participate in the farm activities. I hereby elect to participate in the Planting Justice Farm activities, knowing the potential risks. If an injury or other medical condition occurs or arises and I am incapacitated and/or a parent or guardian cannot be contacted, I hereby give permission to the designated Planting Justice representative to administer first aid and/or to arrange routine medical treatment and/or seek emergency medical treatment. I further authorize any licensed medical person/facility to treat me and/or my child if I cannot be contacted. I agree to assume full financial responsibility for any medical services provided. I hereby give approval for to participate in all activities associated with this Planting Justice event. I assume all risks and hazards related to participation in the program, including transportation. I hereby release Planting Justice staff from liability in the event of illness, injury or loss occurring to my personal belongings or myself and will make no claim as a result thereof. I also understand that some activities/events may involve certain risks associated with physical activity or potential harm, including recreational games/activities and travel by motor vehicle to offsite activities. I have carefully read this agreement and fully understand its contents. I am aware that this is a release of liability and a contract between Planting Justice and myself and I sign it of my own free will. If signed by a Parent or Guardian: I verify that the dangers of the activities and the significance of this Release and Waiver were explained to the Participant and that the Participant understood them. In consideration for my acceptance as a participant at the Farm, and for the services and amenities to be provided by Planting Justice in connection with the Farm, I confirm my understanding that: • I am responsible for my own behaviors toward others at the Farm. Planting Justice is not responsible if I negligently or intentionally injure another person(s) during or in relation to the Farm. • Planting Justice is not responsible if I am injured during the Farm or in relation to a Planting Justice event. • Planting Justice does not allow alcohol or tobacco use on this or any of our sites. Please do not bring these items to any of our locations and do not consume them on-site or arrive under the influence. • Planting Justice strictly forbids the possession or use of illegal substances and un-prescribed prescription drugs at the Farm. I am solely responsible for my actions and bear sole liability for any such possession or use. I understand that I may be personally liable if I provide the same to any other person directly or negligently. • No firearms of any kind are allowed at the Farm • If I bring a minor child to the Farm, I shall bear sole and complete responsibility for the safety, care and behavior of any such child. I understand that Planting Justice shall provide no special programs or accommodations for minors, unless specifically announced and publicized as such. This includes any time I choose to leave such minor unattended. • If I engage in behavior that is disruptive to the Farm community, I understand that Planting Justice reserves the right to dismiss me from the Farm, without refund of fees paid. This Agreement is intended to be as broad and inclusive as is permitted by law. If any provision of this Agreement is held to be invalid or legally unenforceable for any reason, the remainder shall remain valid and fully enforceable. To the fullest extent allowed by law, I agree to WAIVE, DISCHARGE, RELEASE FROM LIABILITY AND COVENANT NOT TO SUE PLANTING JUSTICE, its officers, directors, employees, agents, and leaders from any and all liability on account of, or in any way resulting from injuries and damages in any way connected with this activity at the Farm. I further agree to HOLD HARMLESS Planting Justice, its officers, directors, employees, agents, and leaders from any claims, damages, injuries or losses caused by my own acts and omissions, including but not limited to negli- gence while a participant at the Farm. I understand that this assumption of risk and release is binding upon my heirs, executors, administrators and assigns, and includes any minors accompanying me to the Farm.Please carefully read the agreement and write your name and date below to indicate that you agree. Your full name Date Signed MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Year202320242025 Year Group Code If you are coming with a group, please enter your group code. Media Release Waiver (optional) Agreement Planting Justice is a 501(c)(3) non-profit organization whose mission is to empower people impacted by mass incarceration and other social inequalities with the skills and resources to cultivate food sovereignty, economic justice, and community healing. To accomplish this, we mobilize people, campaigns, and raise money for our work. We are promoting a culture where human rights are embraced, valued and protected starting with the formerly incarcerated and the disenfranchised. We use images of individuals in a number of our campaign materials, both online and in print. To this end, we require your written permission for Planting Justice to use you / your child’s photographic/filmed/recorded image in association with material being compiled to promote Planting Justice’s work. I hereby give my unconditional permission to Planting Justice to use my / my child’s photographic/filmed/recorded image for the purposes of promoting, publicizing, and advertising Planting Justice in its work. I understand that the image(s) will remain the property of Planting Justice and may be used in its publications, website, and other publicity material and I expressly authorize such use. I also understand and acknowledge that once this image is posted onto the Planting Justice website, the image can be downloaded and may be viewed from other websites beyond Planting Justice. I give express permission for Planting Justice to crop or alter the image(s) as necessary. I acknowledge that the image(s) may also be included in the Planting Justice archive.Please carefully read the agreement and write your name and date below to indicate you agree. Your full name Date Signed MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Year202320242025 Year Submit
