Registration Form Day of Service 10/24/21 Participant Name:* First Last This participant is:* Over 18 Under 18 Parent/Guardian Name:* First Last Email:* Main Phone:*Alternate Phone:Mailing Address:* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Do you have any allergies, or are you taking any medications?* Yes No If yes, please explain:* How did you hear about this event?*Web SearchSocial MediaWord of MouthOtherIf other, please explain:* Would you like to receive the TOF e-newsletter?* Yes, please add me to your email list. No, thank you. I already receive the TOF e-newsletter. Assumption of Risk Agreement In consideration of being allowed to participate in any way in The Ojai Foundation’s program and its related events and activities, I, the undersigned, acknowledge, appreciate, and agree that: 1. I agree to follow all current federal, state and local guidelines in regards to COVID-19; 2. I understand that there is risk of injury from the activities involved in this program, including the potential for permanent paralysis and death, and while particular skills, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and, 3. I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of The Ojai Foundation or others, and assume full responsibility for my participation; and, 4. I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of The Ojai Foundation immediately; and, 5. I, for myself and on behalf of my heirs, assigns, personal representatives, and next of kin, hereby release, indemnify and hold harmless The Ojai Foundation, their officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used for the activity, including The Ojai Foundation, with respect to any and all injury, disability, death, or loss or damage to person or property associated with my presence and participation, whether arising from the negligence of The Ojai Foundation or otherwise, to the fullest extent permitted by law. Photographic ReleaseThe Ojai Foundation requests your permission to document their programs with photography of activities and participants. The Ojai Foundation is a non-profit tax-exempt educational organization. Material will be used only for promoting our programs and not for any commercial activity. We greatly appreciate you cooperation and consent. Assumption of Risk Agreement* By checking this box, I certify that: (1) I realize that failure to comply with these policies and protocols may cause serious harm, disability, or death to myself and fellow participants; (2) that the above reflect accurate statements; (3) neither I nor my primary care physician know of any medical reasons why I should not participate in this activity; (4) I have read and fully understand the above terms, (5) I understand that I have given up substantial rights by signing, and (6) sign freely and voluntarily without any inducement. For Parents/Guardians of Minors (under 18 at time of registration)* By checking this box, I certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her/their release as provided above The Ojai Foundation, and for myself, my child, and our heirs, assigns and next of kin, I release and agree to indemnify and hold harmless The Ojai Foundation from any and all liabilities incident to my minor child’s involvement or participation in these programs as provided above, even if arising from the negligence of The Ojai Foundation, to the fullest extent permitted by law. Photographic Release* By checking this box, I certify that: (1) I agree to be photographed in connection with The Ojai Foundations program; (2) that said documents may be used for marketing future programs; and (3) I expressly waive any rights of privacy or proprietary rights or interests in the use of the material. I do not consent to having my photo used for promotional purposes.