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2. If your child is under the care of a physicain for an illness or unjury that may be adversely affected by participating in the Wonders program (e.g. cast, bandages, or stitches that should be kept dry), please submit a signed medical clearance from your preferred medical provider.
4. Student First Name*
5. Student Last Name*
7. Parent/Guardian First Name*
8. Parent/Guardian Last Name*
10. Parent/Guradian Email*
12. Liability Waiver

    Liability Waiver I understand and acknowledge that activities in and around a river entail some level of risk. I, the undersigned, being the volunteer involved in the Wonders On The Wabash program, do hereby, for myself release, discharge, hold harmless, and forever acquit Tippecanoe County, Tippecanoe County Partnership for Water Quality (consisting of Tippecanoe County, City of Lafayette, City of West Lafayette, Purdue University, Town of Battle Ground, Town of Dayton, and Ivy Tech Community College), West Lafayette Parks Department, and their officers, agents, representatives, and employees (hereinafter "the released parties") from any and all actions, causes of action, claims or any liability whatsoever, known or unknown now existing or which may arise in the future on account of or in any way related to or arising out of participation in the event, including without limitation, those arising out of claims that the released parties were negligent. I understand that this waiver is being relied upon as a material inducement to allow participation in the event.

14. Today's Date*
    Today's Date
16. Signature*

    1. As Parent or Guardian, I accept the terms of the Liability Waiver

    The submission of this form shall serve that, in leiu of my signature, I have read, fully understand, and accept all terms of the foregoing Liability Waiver statement.
18. If your child is under the care of a physicain for an illness or unjury that may be adversely affected by participating in the Wonders program (e.g. cast, bandages, or stitches that should be kept dry), please submit a signed medical clearance from your preferred medical provider.
20. Photo Release

    I agree that any photos and/or videos taken of my child while participating in the Wonders on the Wabash program may be used to promote public awareness about the Wabash River, watersheds and water quality in TCPWQ and other program affiliate brochures, newsletters, websites, Facebook, Twitter and other media sources.

22. Approval*

    1. Yes, I give my permission for my child’s photo and/or video to be used for public awareness.
    2. No, my child’s photograph and/or video may not be used for public awareness.
24. Today's Date*
    Today's Date
26. Signature*

    1. As Parent or Guardian, I accept the terms of the Photo Release

    The submission of this form shall serve that, in leiu of my signature, I have read, fully understand, and accept all terms of the foregoing Photo Release statement.

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28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

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