Name *

First Name

Last Name

Cell phone *

(###)

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Person who referred you

First Name

Last Name

Liability Release & Permission *

I have reviewed all of the information provided to me by Pepper Tree Farm.  I understand that by virtue of participation, I may risk bodily injury, death and/or other loss, including damage to property. I understand the facility, Mill Creek Ranch, has not yet met Americans with Disabilities standards, nor has it yet been approved by the American Camping Association. I knowingly and freely assume all of such risks that I may incur from participation in camp activities & special activities. I release & hold harmless Pepper Tree Farm and Mill Creek, the Santa Monica Mountains Conservancy and the Mountains Recreation and Park Authority, and its officers, directors, employees, volunteers, agents, contractors and subcontractors, with respect to any and all claims, losses and damages of any kind, except for those arising from gross negligence or willful acts.

I understand that reasonable measures will be taken to safeguard the health and safety of all participants. In the event my emergency contact cannot be reached, I authorize Pepper Tree Farm, to act on my behalf and to take any and all steps deemed necessary to protect my health and safety.

*

Name as Signature

First Name

Last Name

*

Date Signed

MM

DD

YYYY

Media Release *

Signing this release is a requirement for attending Family Fun Day. I do/do not approve the media release for my image at the Pepper Tree Farm Family Fun Day. This release covers pictures, videos, recordings, writings, and all manner of entertainment.

I DO APPROVE

I DO NOT APPROVE

*

Name as Signature

First Name

Last Name

*

Date Signed

MM

DD

YYYY