P. O. Box 750 Culebra, PR 00775 (o) 787-556-6234 (f) 530-618-4605 e-mail: info@coralations.

org EDUCATIONAL / VOLUNTEER ACTIVITIES ACKNOWLEDGEMENT AND ASSUMPTION OF RISK AND LIABILITY
STATEMENT OF RISKS: There are significant elements of risk in any adventure or sport associated with activities such as hiking in wilderness areas, beach clean ups, kayaking, swimming in the ocean, or working on construction related activities. Although we have taken the appropriate steps to provide you with instructions and staff so that you can enjoy the activity for which you may not be skilled, ACTIVITIES ARE NOT WITHOUT RISK. Certain risks cannot be eliminated without destroying the unique character of the activity. The same elements that contribute to the unique character of the activities can be causes of loss or damage to equipment, causes of accidental injury, illness or, in extreme cases, permanent trauma or death. It is important for you to know in advance what to expect and to be informed of the inherent risks. ***____________ ACKNOWLEDGEMENT OF RISKS: I acknowledge that the following describes some, but not all, of the risks of participation in this activity: 1) possible personal injury from slip and fall accidents on hikes to and from beach, 2) possible injury from solid waste on the beach, 3) possible injury from inclement weather suddenly approaching while on the beach, 4) possible reaction to insect or marine life bites or stings, 5) personal injury as a result of overexertion. 6) fatigue, chill and /or dizziness, which may increase risk of accident. ***__________ I AM AWARE THAT THE ACTIVITY MAY ENTAIL RISKS OF INJURY OR DEATH. I UNDERSTAND THE DESCRIPTION OF THESE RISKS IS NOT COMPLETE AND THAT UNKNOWN OR UNANTICIPATED RISKS MAY RESULT IN THE INJURY, ILLNESS, OR DEATH AS A RESULT OF MY PARTICIPATION IN THE ACTIVITY. __________ EXPRESS ASSUMPTION OF RISK AND RESPONSIBILITY: I agree to assume responsibility for the risks of the activity identified herein and those risks not specifically identified. My participation in the activity is purely voluntary. No one is forcing me to participate. I verify that I am physically fit, not under the influence of alcohol or any drugs at this time and sufficiently qualified, trained and capable of participating in the activity. I assume full responsibility for myself and any minor children for whom I am responsible, for any bodily injury, accident, illness, death, loss of personal property and expenses thereof as a result of any accident which may occur while I participate in the activity. ***__________ COVENANT OF GOOD FAITH: I recognize that you, a provider of services, will operate under a covenant of good faith and fair dealing. I recognize that activities could be cancelled due to forces of nature, medical necessities or other problems and/or refuse or terminate the participation of any person you judge to be incapable of meeting the rigors or requirements of participating in the activity. I accept your right to take such actions for my safety and/or the safety of other participants. ***___________ RELEASE: In consideration of services or property provided, I for myself and any minor children for whom I am parent, legal guardian or otherwise responsible, any heirs, personal representatives or assigns, agree that: CORALations, Inc., its principals, directors, officers, agents, employees and volunteers, their insurer(s) and each and every land owner, municipal and/or governmental agency

upon whose property an activity is conducted ("owner") and their insurer(s), if any SHALL HAVE NO LIABILITY OF ANY NATURE FOR ANY AND ALL DAMAGE TO ME AND OTHER PERSONS OR PROPERTIES as a result of my participation in the activity. This release includes any acts, omissions or negligence of the "owner", the operator named above, or any other person or entity, their agents, employees, partners, contract personnel and their insurer(s) and I hereby release and discharge the owner and operator named above, their employees, agents, or contract personnel and their insurers, if any, for any such damage. ***__________ PROMOTION: Through my participation in this activity I agree that any photos taken during this activity can be used by the organization for promotional purposes. ***____________ ORGANIZATIONAL MEMBERSHIP: Please initial if you are interested in becoming a member of CORALations ***_____________. (membership is free to local residents of PR and USVI) I HAVE READ THE ACKNOWLEDGEMENT OF RISKS, ASSUMPTION OF RISK AND RESPONSIBILITY, AND RELEASE OF LIABILITY AGREEMENT. I UNDERSTAND THAT BY SIGNING THIS DOCUMENT I AM EXPRESSING MY INTENT TO WAIVE VALUABLE LEGAL RIGHTS INCLUDING ANY AND ALL RIGHTS I MAY HAVE OR NOW HAVE AGAINST THE OWNER, THE OPERATOR NAMED ABOVE OR THEIR EMPLOYEES, AGENTS, OR CONTRACT PERSONNEL.

PARTICIPANT INFORMATION Please print: Name: Address: Phone: Email: _______________________________ _______________________________________________________ (Please list any known allergies to plants, insects or medications.) _________________________________________________________ _________________________________________________________ _________________________________________________________

List names of minors under your responsibility: 1) Name and age _________________________________ _______________________________________________________ (Please list any known allergies to plants, insects or medications.) 2) Name and age _________________________________ _______________________________________________________ (Please list any known allergies to plants, insects or medications.) 3) Name and age _________________________________ _______________________________________________________ (Please list any known allergies to plants, insects or medications.) 4) Name and age _________________________________ _______________________________________________________ (Please list any known allergies to plants, insects or medications.) 5) Name and age _________________________________ _______________________________________________________ (Please list any known allergies to plants, insects or medications.) Name and number to contact in case of emergency: __________________________ Name of Contact _____________/______________ Telephone Number(s)

Signature:____________________________________________Date:_________