Virginia Liability Release Form 1

Virginia Adopt-A-Stream Program
Liability Release Form
As a Virginia Adopt-A-Stream Program volunteer, I understand and shall
comply with the Virginia Adopt-A-Stream Program Conditions and Safety Guidelines.
I will exercise care and safety while participating in any program events. I will seek
further direction or explanation of anything not fully understood by me.
I am aware that when boating or canoeing, I must abide by the Virginia
Department of Game and Inland Fisheries (VDGIF) boating regulations. For more
information, contact DGIF at: (804) 367-1125.
As a Virginia Adopt-A-Stream Program volunteer I will at all times indemnify
and save harmless the adopting organization, the Virginia Department of Conservation
and Recreation, the Commonwealth of Virginia, and all Commonwealth employees,
agents and officers, from responsibility, damage, or liability arising from the exercise
of the privileges granted under designated programs.
By voluntarily engaging in a stream cleanup activity, I personally assume all
risks for any harm, injury, or damage during my participation.
Signature _________________________________________________________
Name (please print) _________________________________________________
Date _____________________________________________________________
(DCR 199-024) (01/03)