AmherstCollege Wildlife Sanctuary Research Application

Applicant Information

Name:Date:

Institution:Position/title:

Work address:Home address:

Work phone:Home/mobile phone:

Email:

Emergency contact:If a graduate student, thesis

advisor’s name and email address:

Names and contact information of other individuals to be covered by this research application, such as field assistants and collaborators:

Proposed Research

Title or brief description of research project (< 20 words):

Anticipated start date:Anticipated end date:

Will this project span multiple years? If so, number of years:

Which areas of the Wildlife Sanctuary will be utilized?

On an attached page, please provide a detailed description (200-300 words) of the research you plan to conduct, including the names of all species to be studied. Be explicit with respect to methodology, particularly any proposed manipulations. Please note that under no circumstances can organisms be intentionally introduced from other sites.

Note that any researcher who plans to work with homoeothermic vertebrates must complete an Amherst College Institutional Animal Care and Use Committee (IACUC) application in addition to this application. This application can be obtained by contacting the committee chair, Professor John Cheney ().

Submission of Application

Applications can be submitted electronically to Kristen Gibbons () at the Amherst College Facilities Department. Please write “Wildlife Sanctuary Research Application” in the subject line.

Alternatively, paper applications (8 copies) can be submitted via postal delivery or intercampus mail to Kristen Gibbons, Facilities Administration, 201 Service Building, Amherst College, Amherst, MA 01002.

Please submit applications two months before the proposed start date of your research.

Also, please sign and submit the following “Informed Consent to the Risks” on pages 3 and 4 with your application.

Informed Consent to the Risks

In filing this application, I hereby certify that I understand and accept the risks involved in doing research in this unimproved area. I understand that the area is “wild”, and that paths or other access means are not maintained by the College. Accidents and injuries can occur. I understand that activities in the Sanctuary may be potentially dangerous and that I may be injured and/or lose or damage personal property or suffer financial loss as a result of activities in the Sanctuary. Therefore,I ASSUME ALL RISKS RELATED TO THE ACTIVITIES including but not limited to:

Death, injury or illness from accidents of any nature whatsoever, including but not limited to bodily injury of any nature whether severe or not which may occur as a result my activity or contact with physical surroundings or other persons; arising from contact withwild animals, poisonous snakes, poisonous plants or other naturally occurring phenomenon; death, injury or illness from drowning, hypothermia or other result of my activity in the Sanctuary

Theft or loss of my personal property in the sanctuary

Loss, injury or death as a result of any crime or criminal act by a third party

Loss or injury caused by any natural disaster or other disturbances or loss or researchor alteration or cancellation of this agreement due to such causes

I further acknowledge that the above list is not inclusive of all possible risks associated with the use of the Sanctuary and that the above list in no way limits the extent or reach of this release and covenant not to sue. I further understand that working in the Sanctuary is an acceptance of risk of injury or death.

Indemnity Agreement

In consideration of Amherst College providing access to the Sanctuary, I agree, to the fullest extent permitted by Law, to defend, indemnify and hold harmless the Trustees of Amherst College, including its current and former trustees, officers, directors, employees, volunteers, agents, assigns and students from and against claims, damages, losses and expenses, including but not limited to attorney's fees, arising out of, or from the performance of my operations or activities, or any act, omission, claim or loss of any of my employees, agents, volunteers, participants, guests or any other party I am responsible for, regardless of whether or not such claim, damage, loss or expense is caused in part by a party indemnified hereunder. This obligation shall not negate, abridge or reduce other rights or obligations of indemnity that would otherwise exist in the absence of this agreement.

Release from Liability, Indemnification Agreement and Covenant Not to Sue

In consideration of Amherst College’s permission to use the Sanctuary, I, to the fullest extent permitted by law, agree to forever release and on behalf of myself, my spouse, heirs, representatives, executors, administrators and assigns, hereby do forever release Amherst College from any cause of action, claims, or demands of any nature whatsoever, including but not limited to a claim of negligence which I or my spouse, heirs, representatives, executors, administrators and assigns may now have, or have in the future against Amherst College on account of personal injury, bodily injury, property damage, death or accident of any kind, arising out of or in any way related to my use of the Sanctuary and/or the use of facilities, equipment, or services in association with the Sanctuary howsoever the injury is caused, whether by the negligence of Amherst College or otherwise.

In consideration of Amherst College’s permission to use the Sanctuary Icovenant not to sue Amherst College for any and all causes of action, claims, demands, losses or costs of any nature whatsoever arising out of or in any way relating to my use of the Sanctuary or my use of facilities, equipment, or services in connection with the Sanctuary.

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Signature of Applicant

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Printed Name of Applicant

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