This form is intended to prevent persons from suing for damages in certain circumstances. The undersigned, on behalf of their minor child noted below and themselves, are participating in activities at Wild Goose Farm operated by Kathy and David Kristjanson-Gural of Lewisburg, Pennsylvania.


As a condition of participation at Wild Goose Farm, the undersigned agrees that:


1. THEY HEREBY RELEASE, WAIVE AND DISCHARGE AND AGREE not to sue Kathy and David Kristjanson-Gural, the instructors, and/or volunteers FROM ALL LIABILITY for any loss or damage, and any claims or demands therefore on account of injury to the person of the undersigned or their children, arising from participation at Wild Goose Farm, from contact with plants, insects, animals, or presence in their woods, barns outbuilding, farmhouse or otherwise.



2. THEY ASSUME FULL RESPONSIBILITY FOR AND RISK OF BODILY INJURY TO THEMSELVES AND THEIR CHILDREN due to any negligence of David and Kathy Kristjanson-Gural, the instructors, and/or volunteers. 


I understand that this is a RELEASE OF LIABILITY and that I have read this RELEASE before signing. 





Name of Parent/Guardian___________________________________


Names of Children:___________________________________________


Signature of Parent/Guardian_____________________________________________




If we get an incredibly beautiful photo of you and/or your child while you are at Wild Goose Farm, may we have your permission to use it on our website or other publications (newsletter etc.) to tell other parents about Wild+Free and Wild Goose Farm?


For yes, please sign below. Thanks!




Wild Goose Farm, 2099 Beaver Run Rd

Lewisburg, PA 17837    

(570) 523-8919 or email wildgoosefarmpa@gmail.com


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2099 Beaver Run Road Lewisburg, PA 17837

Phone: 570.523.8919

© 2023