YOUTH PERMISSION AND WAIVER FORM

The Clackamas River Basin Council greatly appreciates your interest in our watershed and welcomes you to this bike ride. Thank you! We request a parent or guardian of youth volunteers complete this Permission and Waiver Form. In order to participate, your child must bring this signed form to the bike site.

I (print parent's/guardian's name) _______________________________verify that (print youth's name) _____________________________, has permission to participate in the bike ride. Location: Throughout Clackamas County on Date: July 7, 2012

By my signature below, I do release and indemnify, defend and hold harmless, the Clackamas River Basin Council from and against any and all claims, actions, suits, or proceedings of any kind or nature arising as a result my childs involvement in this activity. Volunteer activities may include the following: Biking on rough/uneven terrain in a variety of weather situations and locations I also release the staff and Board of Directors of Clackamas River Basin Council, without limitations, from damages, liabilities, penalties, costs, expenses, legal fees, and claims.

Please print the following information:

Youth Name: _________________________________________________________ Address: _____________________________________________________________ Phone number: ____________________ Age of Participant: ____________________ Parent/Guardian Name (Please print):______________________________________ Relationship to Youth: __________________________________________________ Date: _____________ Signature of Parent/Guardian: __________________________

Please Initial One: _______ I grant the Clackamas River Basin Council irrevocable and unrestricted right to use
and publish photographs of the participant. _______ I do not grant the Clackamas River Basin Council irrevocable and unrestricted right to use and publish photographs of the participant.