TOTAL DUE: $130 per Safari Participant
Please make your check payable to The Darkroom and mail
with this Registration and a copy of the completed "Assumption
of Risk,Waiver and Release of Liability"for each Safari
Participant.
You will receive confirmation of receipt of your registration. Directions and a list of recommended equipment and supplies will be available to you at the Friday class meeting. Contact The Darkroom for further instructions if you are unable to attend the Friday meeting.
Cancellation Policy: If you need to withdraw from the Photo Safari after your payment has been made, The Darkroom will refund your payment, less a $25 non-refundable fee, within ten days of receipt of your written notification by either mail or email (email address: safari@darkroomz.com), providing it is received on or before the "Deadline for Refundable Cancellation". If, for whatever reason, any such notification is received after the "Deadline for Refundable Cancellation", your payment, less the $25 non-refundable portion, may be applied toward other activities offered by The Darkroom (photo safari, class, workshop, lab time, etc.).
If it is necessary for The Darkroom to cancel the Photo Safari, all registered participants will be informed as soon as possible, and you will receive a full refund of all fees paid. Notification of cancellation due to insufficient registration will be made at least ten days prior to the beginning date of the Photo Safari. The Darkroom will not be responsible for any losses you may incur related to cancellation.
WHAT IS INCLUDED:
REGISTRATION INCLUDES FERRY RIDE TO AND FROM SAN FRANCISCO Blue and Gold Ferry DOCK, ORIENTATION AND TECHNIQUES DISCUSSION ON FRIDAY NIGHT, AND ALL FIELD INSTRUCTION ON SATURDAY NIGHT.
TOTAL AMOUNT ENCLOSED FOR _____ SAFARI PARTICIPANT(S): $__________
SAFARI PARTICIPANT(S) NAME(S)___________________________________________________________________
ADDRESS__________________________________________________________________________________________
PHONE_______________________________day eve
EMAIL________________________________________________________________
NUMBER OF PEOPLE IN YOUR PARTY______
Please indicate names of any non-participant adults and number
of minors under 18:
_________________________________________________________________________________________________
Please complete the following information if registrant is under 18 years of age:
EMERGENCY PHONE (weekends/evenings)______________________________
MEDICAL PLAN Name__________________________________ID Number_____________________
PHYSICIAN_____________________________________________PHONE_______________________
Each Safari participant (or parent/guardian if Safari participant is a minor) must read, sign and return an Assumption of Risk, Waiver and Release of Liability form below.
Please read, sign and return with your registration packet:
ASSUMPTION OF RISK, WAIVER AND RELEASE OF LIABILITY, INCLUDING NEGLIGENCE
I, (please print)_________________________________________, agree to each and all of the following in connection with my participation in the night photography course conducted by The Darkroom, which includes the instruction session on August 11, 2006 in Martinez, California and the field outing workshop on August 12, 2006 at Alcatraz Island, California and surrounding areas:
1) I am a healthy adult, voluntarily participating in this photography
outing workshop and I assume all risks of illness, injury, death,
damage and/or loss to myself or my property that might result.
2) On behalf of myself and my personal representatives, heirs,
executors, administrators, agents and assigns, I hereby release
and discharge in advance J. Michael (Jerry) Ott, Linda Ott and
The Darkroom (and its owners, employees, instructors, agents,
representatives and assigns) from any and all liability, even
if that liability arises out of negligence and/or carelessness
on the part of the persons or entities mentioned above.
3) My assumption of risk, waiver and release of liability, including
negligence, encompasses, but is not limited to: death, bodily
injury, illness, damage, theft and/or loss of personal property
during said workshop which occurs as a result of anything during
the entire workshop. The following are some, but not all, of the
possibilities:
a) traversing uneven ground, with or without
photographic equipment in order to access off-road photography
sites;
b) natural hazards, such as, but not limited
to, steep cliffs, hazardous footing, busy roadways, dimly lit
building interiors and exteriors, and/or poison oak;
c)
transportation to and from Alcatraz Island via the public ferry
service;
d) negligent instruction and/or supervision
by any of the persons involved in the workshop on behalf of The
Darkroom.
Consent of Parent or Legal Guardian (if registrant is under 18 years of age):
I certify 1) that I am the parent or legal guardian of (minor
child)_______________________________, 2) that my child is
healthy and in adequate physical condition to participate in the
activities involved in the class(es), workshop(s) and/or field
outing(s) named on this course registration,
3) that my child is a voluntary participant in said activities,
4) that I give my permission for him/her to participate in said
class(es), workshop(s) and/or field outing(s),
5) that my child and I assume all risks of illness, bodily injury,
death, damage, theft and/or loss to my child/ward or personal
property that might result
and 6) that I hereby execute on his/her behalf the Assumption
of Risk, Waiver and Release of Liability, Including Negligence.
In the event of an emergency, I authorize The Darkroom and its owners, employees, instructors, agents, representatives and assigns to secure from any licensed hospital, physician, and/or medical personnel any treatment deemed necessary for my minor child's/ward's immediate care and agree that I will be responsible for payment of any and all medical services rendered.
I have carefully read this Assumption of Risk, Waiver and Release of Liability, Including Negligence. I am aware that both predictable and unpredictable risks are involved during the classes, workshops and field outings conducted on behalf of The Darkroom. I hereby agree to assume all of those risks and to release and hold harmless all of the persons or entities mentioned above who through negligence or carelessness would otherwise be liable to me or to my heirs or assigns for damages, or to my minor child or to my child's heirs or assigns.
Signed__________________________________
Dated___________________________