ORKESTAI FARM

Organic Growers Course Registration 2025

at Orkestai Farm within Planting Fields Arboretum, Oyster Bay, NY

Season Dates: April 15 - November 7, 2025

Designated Representative Contact Information

NOTE: We may need to contact a designated representative (eg. Parent, Program Director, etc) during the course of the program. By providing contact information below, you are giving us permission to reach out to the provided contact and discuss the participant listed above in all respects, including in the event of any incidents.

Parent/Guardian Information

Participating Support Person Contact Information

NOTE: If the Participant will be accompanied by support, the individual will need to fill out our Support Staff Form. Please designate the individual below. (eg: DSP, paraprofessional, shadow, therapist)

School/FI/Agency/Organizational Affiliation (if applicable)

Biosocial Information (Please provide any information in the boxes below that would be helpful for us during this program)

 

In the event emergency medical aid or treatment is required due to illness or injury during the process of receiving services, or while being on the farm, I authorize ORKESTAI FARM, INC. to:

1. Obtain medical treatment and transportation, as needed.
2. Release client records as requested by the authorized individual or agency providing medical emergency treatment.

I authorize the medical professionals consulted in the event of emergency to provide the medical treatment they deem appropriate. This may include but is not limited to x-rays or other imaging studies, blood tests, medications, surgeries, or hospitalization, and any treatment procedure deemed “life saving” by the physician.  It is understood that this provision will only be invoked if the specified contacts cannot be reached within a reasonable time period.

BY SIGNING THIS DOCUMENT YOU WILL WAIVE LEGAL

RIGHTS INCLUDING THE RIGHT TO SUE

I, the undersigned, wish to participate in the Orkestai Farm Organic Growers program (the “Program”) located at 1395 Planting Fields Road, Oyster Bay, NY 11771 (the “Location”) by Orkestai Farm, Inc., a corporation organized under the laws of the State of New York (“Orkestai”).

I wish to participate in the Program at the Location, and hereby assume all risks of engaging in the Program. These risks include, but are not limited to, bodily injury, whether from tool-use, weather, physical exertion, unexpected behavior, insect bite, obstacles, and other obvious and non-obvious risks

I also hereby hold harmless and release Orkestai, its members, managers, employees and agents, as well as Alethea Vasilas and Joshua Marcus in their individual capacity (collectively, “Indemnitees”) and indemnify each of them from and against any and all loss, claim, cause of action, lawsuit, damage, liability, cost or expense whatsoever which any of them may incur arising out of or in connection with my participation in the Program at the Location or off the premises.

I hereby certify that I am at least 18 years of age (or, if less than 18 years of age, have caused this Liability Waiver and Release to be signed by my parent or legal guardian), I agree that neither I nor any member of my family will sue any Indemnitee because of my participation in the Program or my presence at the Location at any time, and I understand that this Release shall be binding upon my estate, my heirs, next of kin, executors, administrators, representatives, successors and assigns. I specifically waive any claim or right to assert any cause of action or alleged case of action or claim or demand which has, through oversight or error intentionally or unintentionally or through a mutual mistake, been omitted from this Liability Waiver and Release.

I HAVE READ AND UNDERSTOOD THIS LIABILITY WAIVER AND RELEASE, HAVE HAD THE OPPORTUNITY TO HAVE LEGAL COUNSEL REVIEW THIS LIABILITY WAIVER AND RELEASE, AND I AM AWARE THAT BY SIGNING THIS LIABILITY WAIVER AND RELEASE I AM WAIVING CERTAIN LEGAL RIGHTS WHICH I OR MEMBERS OF MY FAMILY, MY HEIRS, NEXT OF KIND, EXECUTORS, ADMINISTRATORS, REPRESENTATIVES, SUCCESSORS AND ASSIGNS MAY HAVE AGAINST ORKESTAI FARM, INC., ITS OWNERS, MANAGERS, EMPLOYEES AND AGENTS.

The undersigned irrevocably grants permission and consents to the Participant's participation in the Program at the Location described in the foregoing Liability Waiver and Release. 

Protecting the Client and Others from Harm:

If we have reason to suspect that a minor or disabled person is being abused, we may be required to report such suspected abuse (and any additional information if requested) to the appropriate state agency. If we believe that a participant is threatening serious harm to him/herself or others, we may be required to take protective actions which could include notifying the police, the intended victim, a minor's parents, or others who could provide protection, or appropriate intervention.

I hereby authorize Orkestai Farm and those acting pursuant to Orkestai Farm and its authority to: 

1. Photograph and/or take video of me;

2. Edit, use, reproduce, exhibit and distribute these photographs and/or videos, in whole or in part, in any manner and media now known or herein invented, including, but not limited to, print publications, Orkestai Farm’s website, online social media, in perpetuity throughout the world, in support of and/or to promote their programs, services, and mission and for archival purposes. I hereby waive the right to inspect or approve any of the photographs and/or videos. I understand that Orkestai Farm will be the exclusive owner of all such photographs and/or videos and that I will not receive any compensation for the use of the photographs and/or videos.  I expressly release and hold harmless Orkestai Farm, and those acting pursuant to Orkestai Farm or its authority from liability for any claims by me or any third party for the actions of Orkestai Farm in reliance of this consent and release.

For any questions or concerns, please reach out!  Email: info@orkestaifarm.org