Adult and Youth Permission and Release Agreement

The undersigned hereby represents that he/she is

a) An adult volunteer, 18 years of age or older or

b) a parent or legal guardian of a minor child under the age of 18. I hereby give my consent for the above named-minor to attend and actively participate in Alex Haase’s Hayman Restoration Eagle Project. I understand that activity includes working in the open using a hoe to clear a 3 foot circle of weeds and undergrowth from around Pine seedlings during the extent of the activity. My child/ward has my permission to be transported to and from the work area in the Hayman Burn area. I understand that the work area is along Forest Road 211 approximately 7.2 miles West of its intersection with Jefferson County 126. I understand that the drop-off/pick-up point is in the parking lot of the Woodland Park Community Church, 800 Valley View Drive, in Woodland Park, and that I am responsible for the timely arrival for departure and pickup of my child. The work days that this permission form is valid for include(check all that apply):

q Saturday Morning, September 18th	q Saturday Morning, October 2^nd
q Saturday Afternoon, September 18^th	q Saturday Afternoon, October 2^nd
q Saturday Morning, September 25^th	q Saturday Morning, October 9^th
q Saturday Afternoon September 25^th	q Saturday Afternoon, October 9^th

I further understand that I am responsible for ensuring that my child is properly outfitted for this activity. Such outfitting includes a hat, work gloves, sunscreen, water bottle, stout shoes, seasonal layering, wind breaker and or rain gear, and any medications my child would normally have during mildly strenuous exercise. I have annotated on the reverse side of this form all medical conditions and medications (including allergies and asthma) medical support personnel may need to know about.

I further understand and agree that by signing this form I authorize the activity organizers to seek and obtain whatever medical treatment they deem necessary for my child/ward during this activity and I accept full responsibility for any costs incurred including treatment and transportation. I further agree to release the activity organizers and organizations from any claim by me, my heirs and assigns arising from medical treatments of any kind.

I understand and agree that outdoor activities pose both known and unknowable risks which include accidents, mistakes, missteps, and Acts of God beyond the control of the activity organizers. I understand and agree that in signing this agreement that I agree to release and hold harmless the organizers and organizations supporting this activity from any claim by me, my heirs and assigns arising from my or my child/wards participation in this activity.

I further agree to the terms of Forest Service Form FS-1800-8(7/91) (a fully executed copy of which is available to me upon request) which provides in the AGREEMENT FOR SPONSORED VOLUNTARY SERVICES, paragraph 5, that the work [on this project] will be contributed to the Forest Service and the work contributed by the participants will not confer on them the status of federal employees and, in the ACCEPTANCE FOR THE FOREST SERVICE, paragraph 3, which provides that while the agreement is in effect, to consider the participants as federal employees for the purpose of tort claims and compensation for work injuries, to the extent not covered by the sponsor.

I further agree that I accept full responsibility for my/my child/wards safety and risk while participating on this activity.

Medical Insurance Provider :_______________________ group/subscriber number _________________.

Signed : ___________________________________ Date: ________________________

Printed Name: ___________________________________

Contact Phone: Alternate Contact Phone: