Lucky Puppy LLC, dba Baby Bear Farm Waiver
Name: _____________________________________________________
Email Address:_______________________________________________
Phone Number: ______________________________________________
Address: ___________________________________________________
Emergency Contact’s Name: ______________________________________
Phone Number: ______________________________________________
Any Allergies / Other Relevant Medical Information:_____________________
_______________________________________________________
_________________________________________________________
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VISTORS / GUESTS MUST COMPLETE THIS INFORMATION FORM AND SIGN THE WAIVER AND RELEASE
PARENT/LEGAL GUARDIAN SIGNATURE IS REQUIRED IF VISTOR / GUEST IS UNDER AGE 18
Lucky Puppy LLC, dba Baby Bear Farm www.BabyBearFarm.com
WAIVER AND RELEASE OF LIABILITY
Please read carefully. This is a legal document.
The undersigned individual (hereafter referred to using “I”, “me”, “my”, “myself”, “Guest” or “Visitor”) wishes to visit/work/participate as a Guest of Lucky Puppy, LLC dba Baby Bear Farm (“Baby Bear Farm”). Guest (and Parent/Legal Guardian) understands that being a Guest of Baby Bear Farm may include, but not limited to, performing physical labor, handling food products, working with various tools and equipment, planting and harvesting crops, weeding or preparing the fields, and any other tasks and activities incidental or related to the operation of Baby Bear Farm (the “Guest Activities”). Participation as a Guest involves certain risks, including, but not limited to, serious injury, and I am voluntarily participating in the Guest Activities with knowledge of the potential danger involved. I understand that I will be expected to be safe to myself and others while at Baby Bear Farm.
On behalf of myself and my family, guardians, estate, beneficiaries, heirs, successors and assigns, I (and Parent/Legal Guardian of Guest if Guest is under age 18) hereby release, discharge and forever hold harmless Lucky Puppy, LLC dba Baby Bear Farm and its owners and employees (collectively, the “Organization”) from all present and future claims or demands for property damage, personal injury, wrongful death and any other liability of whatever kind that may arise as a result of my participation in the Guest Activities. I also agree to indemnify and hold harmless the Organization for all claims arising out of or relating to my participation in Guest Activities. I understand and agree that the Organization is not responsible for any injury or damage arising out of the Guest Activities, including any injury or damage alleged to have arisen out of negligence by the Organization.
I have disclosed any and all allergies or relevant medical conditions to the Organization on the Waiver Information Form. I agree that Lucky Puppy, LLC dba Baby Bear Farm is not responsible for administering medical treatment of any kind.
I hereby irrevocably grant and assign to the Organization all right, title and interest in and to any and all photographic images and audio or video recordings of me made by the Organization during the Guest
Activities.
I understand that this waiver and release is intended to be as broad and inclusive as permitted by the laws of the Commonwealth of Virginia, and that it shall be governed by and interpreted in accordance with the laws of the Commonwealth of Virginia. I agree that if any portion of this waiver and release is invalid, the remainder will continue in full legal force and effect.
I am the Guest or the Parent/Legal Guardian of the Guest. I have read and understood this document, and I am freely and voluntarily, and without any pressure or duress, signing this waiver and release. I am of legal age.
(Print Name of Guest):
(Print Name of Parent/Legal Guardian if Guest is Under 18):
(Signature of Guest or Parent/Legal Guardian if Guest is Under 18):
Date:
