AMHERST COLLEGE WILDLIFE SANCTUARY RESEARCH APPLICATION

APPLICANT INFORMATION

Name: Date:

Institution: Position/title:

Work address: Home address:

Work phone: Home/mobile phone:

Email:

Emergency contact: If a graduate student, thesis

advisor’s name and email address:

Names and contact information of other individuals to be covered by this research

application, such as field assistants and collaborators:

PROPOSED RESEARCH

Title or brief description of research project (< 20 words):

Anticipated start date: Anticipated end date:

Will this project span multiple years? If so, number of years:

Which areas of the Wildlife Sanctuary will be utilized?

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On an attached page, please provide a detailed description (200-300 words) of the
research you plan to conduct, including the names of all species to be studied. Be explicit
with respect to methodology, particularly any proposed manipulations. Please note that
under no circumstances can organisms be intentionally introduced from other sites.

Note that any researcher who plans to work with homeothermic vertebrates must
complete an Amherst College Institutional Animal Care and Use Committee (IACUC)
application in addition to this application. This application can be obtained by contacting
the committee chair, Professor John Cheney (jtcheney@amherst.edu).

SUBMISSION OF APPLICATION

Applications can be submitted electronically to Joanne Gustafson

(jlgustafson@amherst.edu) at the Amherst College Facilities Department. Please write
“Wildlife Sanctuary Research Application” in the subject line.

Alternatively, paper applications (8 copies) can be submitted via postal delivery or

intercampus mail to Joanne Gustafson, Facilities Administration, 201 Service Building,
Amherst College, Amherst, MA 01002.

Please submit applications two months before the proposed start date of your research.

Also, please sign and submit the following “Informed Consent to the Risks” on pages 3
and 4 with your application.

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Informed Consent to the Risks

In filing this application, I hereby certify that I understand and accept the risks involved
in doing research in this unimproved area. I understand that the area is “wild”, and that
paths or other access means are not maintained by the College. Accidents and injuries
can occur. I understand that activities in the Sanctuary may be potentially dangerous and
that I may be injured and/or lose or damage personal property or suffer financial loss as a
result of activities in the Sanctuary. Therefore, I ASSUME ALL RISKS RELATED
TO THE ACTIVITIES including but not limited to:

 Death, injury or illness from accidents of any nature whatsoever, including but not
limited to bodily injury of any nature whether severe or not which may occur as a result
my activity or contact with physical surroundings or other persons; arising from contact
with wild animals, poisonous snakes, poisonous plants or other naturally occurring
phenomenon; death, injury or illness from drowning, hypothermia or other result of my
activity in the Sanctuary
 Theft or loss of my personal property in the sanctuary
 Loss, injury or death as a result of any crime or criminal act by a third party
 Loss or injury caused by any natural disaster or other disturbances or loss or research
or alteration or cancellation of this agreement due to such causes

I further acknowledge that the above list is not inclusive of all possible risks associated
with the use of the Sanctuary and that the above list in no way limits the extent or reach
of this release and covenant not to sue. I further understand that working in the
Sanctuary is an acceptance of risk of injury or death.

Indemnity Agreement

In consideration of Amherst College providing access to the Sanctuary, I agree, to the

fullest extent permitted by Law, to defend, indemnify and hold harmless the Trustees of
Amherst College, including its current and former trustees, officers, directors, employees,
volunteers, agents, assigns and students from and against claims, damages, losses and
expenses, including but not limited to attorney's fees, arising out of, or from the
performance of my operations or activities, or any act, omission, claim or loss of any of
my employees, agents, volunteers, participants, guests or any other party I am responsible
for, regardless of whether or not such claim, damage, loss or expense is caused in part by
a party indemnified hereunder. This obligation shall not negate, abridge or reduce other
rights or obligations of indemnity that would otherwise exist in the absence of this
agreement.

RELEASE FROM LIABILITY, INDEMNIFICATION AGREEMENT AND COVENANT NOT TO

SUE
In consideration of Amherst College’s permission to use the Sanctuary, I, to the fullest
extent permitted by law, agree to forever release and on behalf of myself, my spouse,
heirs, representatives, executors, administrators and assigns, HEREBY DO FOREVER
RELEASE Amherst College from any cause of action, claims, or demands of any nature
whatsoever, including but not limited to a claim of negligence which I or my spouse,
heirs, representatives, executors, administrators and assigns may now have, or have in the
future against Amherst College on account of personal injury, bodily injury, property
damage, death or accident of any kind, arising out of or in any way related to my use of

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the Sanctuary and/or the use of facilities, equipment, or services in association with the
Sanctuary howsoever the injury is caused, whether by the negligence of Amherst College
or otherwise.

In consideration of Amherst College’s permission to use the Sanctuary I COVENANT NOT

TO SUE Amherst College for any and all causes of action, claims, demands, losses or
costs of any nature whatsoever arising out of or in any way relating to my use of the
Sanctuary or my use of facilities, equipment, or services in connection with the
Sanctuary.

___________________________________________
Signature of Applicant

____________________________________________
Printed Name of Applicant