Zimmer Club Youth Conservation Program of Staten Island, Inc.

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PARTICIPANT HOLD HARMLESS AGREEMENT

I do hereby give permission for my child or ward to participate in what is generally considered a harmless or a low risk of injury event, even though this event may be perceived by others, as dangerous and/or hazardous. I also, on behalf of this registrant, hold harmless the Zimmer Club Youth Conservation Program of Staten Island Inc (ZCY) and the Organization(s) indicated below during a sponsored Youth Activity, Tournament, Program, or Game in which he or she may participate.

Andrew E. Zimmer, Fish & Game Protective, Association; Richmond Boro Gun Club; Colonial Rifle & Pistol Club; NRA; USA Archery; Staten Island Sportsman Club; NYC Department of Youth & Community Development; NYC Department of Parks & Recreation; NYS Department of Parks and Historic Preservation; and their affiliated members; Federal, NYS, or NYC Agencies, and any other Organization's location being used to stage an event, where my child or ward is identified on this form I also give permission or allow:

  1. An electronic attendance sheet or club identification card to be generated with my child or ward’s picture, signature and/or name printed on it.

  2. An electronic authorization signature sheet with my child or ward’s name printed on it which can be reproduced or used in conjunction with their activities when required during a program or event.

  3. My child or ward, myself, family member, friend or child who accompanies us, to be identified and/or photographed when used in any activity, promotion or advertisement to promote the organization, event, or program they are attending or participating in.

  4. My child or ward to participate in an activity when an alert is indicated on this registration form. It will be my responsibility to constantly monitor my child or ward’s event participation and will not hold the above organizations responsible for any oversight, sickness or injuries resulting from their participation.

  5. A person I designate to provide all required transportation to and from a sponsored event.

  6. My child or ward to participate in any other activities of the ZCY, now and in the future.

  7. I will pay compensation, when required, for all damage to equipment and/or property my child or ward may use or be responsible for.


I have read this “Participant Hold Harmless Agreement.” I acknowledge its contents by affixing my signature or electronic signature to this ZCY participant’s registration form.

revised 2018

* Required