MHLC Nature Passport Completion Form

STEP 1. Register your Capital Region Nature Passport.
Did you register your passport when you started your adventures? If not, stop here. Please register your passport now, then return to this form. Register your passport here.
*Please note: all participants under 18 must be registered with a parent/guardian listed as the primary contact. 

 

STEP 2. Have fun while completing all 25 micro-adventures.
 
STEP 3. Complete the form below!

Congratulations on your accomplishment! Fill out the form below and receive your certificate of achievement and MHLC sticker!


Save the natural lands of the Capital Region!

Make a tax-deductible donation to support the Mohawk Hudson Land Conservancy and its efforts to conserve the natural lands of the Capital Region. Please contribute today! 


 

Please fill in completely

Please let us know how we should recognize your accomplishment on your certificate of achievement. You may select to receive one certificate for your family (e.g. The Jones Family) -OR- you may select to receive individual certificates for each member of your family (we will use the names/spellings that you provided with your Passport Registration).  

 

Please select your choice below.

If you selected a family certificate, please let us know the last name to use.

Please tell us about your 25 adventures


First Adventure: Date Completed
Last Adventure: Date Completed
Why?
Please share your ranking of the top 3 adventures & why.
Please share your least favorite adventures & why.

 


 

Please let us know where we should send your certificate of achievement and sticker.

Country*
State / Province*
Address*
City*
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Email*
Confirm Email*
Phone*

Release & Waiver of Liability

FOR ALL EVENTS
Please read carefully, this document affects your legal rights.

 

In consideration of my acceptance as a participant in the activities sponsored by The Mohawk Hudson Land Conservancy, and the services and amenities provided by the Mohawk Hudson Land Conservancy, I agree to the following:

Release and Waiver: I hereby release from liability, indemnify and hold harmless the Mohawk Hudson Land Conservancy, its officers, directors, owners, agents, volunteers, activities coordinators, sponsors, suppliers, supporters, landowners, other affiliated organizations, and their employees and agents (collectively “MHLC”) from any and all claims that I may now have or which I may hereafter have for property damage, injury, illness, or death which I may suffer or for which I may be liable to others, arising out of or in any way connected with my participation in any activities associated with MHLC (“Activities”). I understand that this release and waiver of liability applies to all claims, including negligence by MHLC, under any theory of recovery except claims based upon intentional misconduct.

Activities: I understand the Activities include, but are not limited to: hiking, biking, planting, pulling weeds, and transportation to and from the activity site, and environmental hazards including, but not limited to: uneven terrain, rivers and streams, falling branches or trees, inclement weather, reaction to plants or insects, harm resulting from contact with animals, etc.

Safety: I understand that during my participation in the Activities, I may be exposed to a variety of hazards and risks, foreseen or unforeseen, which are inherent in the Activities and I appreciate that I may have to exercise extra care for my own person and for others around me in the face of such hazards. I agree to read, listen to, and follow all safety instructions presented in conjunction with the Activities; to use good judgment based on physical ability and to immediately terminate participation in the activity if activities become too difficult or if for any other reason I feel uncomfortable. If I decide to leave early and not to complete the Activities as planned, I assume all risks inherent in my decision to leave and waive all liability against MHLC arising from that decision. Likewise, if the activities coordinator has concluded the Activities, and I decide to go forward without the activities coordinator, I assume all risks inherent in my decision to go forward and waive all liability against MHLC arising from that decision.

Assumption of the Risk: I understand the Activities may be hazardous and I hereby expressly and specifically assume the risk of injury or harm in the Activities and release MHLC from all claims of liability for property damage, injury, illness, or death resulting from the Activities, including claims under a theory of negligence.

Medical Care: I understand that there may not be rescue or medical facilities immediately available for the injuries I may suffer from the hazards and risks to which I may be exposed, and I agree that I am responsible for my own medical care. However, if I do receive medical care in the event of an emergency (for instance, if I am unconscious) I do release MHLC from any and all claims resulting from any first aid, treatment, or service rendered.

Insurance: I understand MHLC does not provide any health, medical, or disability insurance for participants in the Activities (“Participants”).

Photographic Release: I hereby grant and convey unto MHLC all rights, title, and interest in any and all photographic images and video or audio recordings made by MHLC during the Activities with the Land Trust, including but not limited to, any royalties, proceeds, or other benefits derived from such photographs or recordings. I grant permission to MHLC to use photographs taken by and/or of me for use in publications, including websites or other electronic forms or media, and to offer the photographs for use or distribution in all manners, for advertising, trade, promotional and other related lawful purposes without notifying me.  I grant permission to MHLC to use my comments in this form in their print and electronic promotional materials.

Severability: I agree if any part of this Waiver is determined to be unenforceable, it is intended that all other terms be enforced.

Termination of Agreement: I agree this Waiver is binding until MHLC receives a statement in writing that I no longer agree to the terms in this Waiver.

I HAVE READ AND UNDERSTAND THIS AGREEMENT IN ITS ENTIRETY PRIOR TO REGISTERING FOR THIS MHLC EVENT, AND I AM AWARE THAT BY ELECTRONICALLY SIGNING THIS WAIVER, I AM WAIVING CERTAIN LEGAL RIGHTS WHICH I AND/OR MY CHILD MAY HAVE AGAINST MHLC, INCLUDING ANY CLAIMS FOR NEGLIGENCE OF MHLC. I NEVERTHELESS ENTER INTO THIS AGREEMENT FREELY AND VOLUNTARILY AND AGREE IT IS BINDING UPON ME, MY HEIRS, ASSIGNS, AND LEGAL REPRESENTATIVES. WITH THIS ELECTRONIC REGISTRATION I CERTIFY THAT I AM AT LEAST 18 YEARS OLD AND PHYSICALLY FIT TO PARTICIPATE IN THE ACTIVITIES. IF I AM SIGNING AS A PARENT OF GUARDIAN I ACKNOWLEDGE THAT I MAKE THIS AGREEMENT ON BEHALF OF MY MINOR.

 

I agree to the above waiver*
  • Yes
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