Parental permission must be secured for participants who are under the age of 18 years of age.
I am aware in signing this document that certain risks and dangers exists in the activities in which my child or I may be participating. I acknowledge that while Dubuque County Conservation Board (DCCB) staff will make every reasonable effort to teach my child or me proper safety and minimize exposure to known risks, all dangers associated with these activities cannot be foreseen. These risks may include, but are not limited to, the loss or damage of personal property, injury or fatality due to inclement weather, slipping, falling, insect bites, falling objects, hyperthermia (heat exposure), hypothermia (cold exposure), or suffering any type of accident or illness in remote areas without immediate access to medical facilities, or while traveling to or from activity sites. I have a personal responsibility to make sure my child and I understand and follow the safety standards, guidelines, and procedures established by the DCCB staff or other medical personnel to treat my child or me in an emergency situation. Also by signing below you will agree to the Dubuque County HIPPA privacy report notice because of the Emergency Medical information you have filled out. The report states that DCCB will not give out any personal information to the public.
If my child will be taking any medications, it will be sent in the prescription bottle with clear instructions as to when it should be taken. The medication shall be in the care of the DCCB staff and will be dispensed as prescribed.
I understand that the programs at DCCB are subject to inclement weather. In the case of necessary changes, I understand a program of equal value will be substituted and my program fee will be used for this purpose. Weather related refunds are not allowed as long as a program continues.
I also agree, unless I explicitly request otherwise, that photographs taken during this program may be used for promotional purposes by DCCB.
