Liability Release Form

I, being 21 years of age or older, do for myself (and for or on behalf of my child participant, if said child is not of age or older) do hereby release, forever discharge and agree to hold harmless

(Name of Group)   ____________________________________________________ and

(Trip Organizer)   _____________________________________________________ and

(Activity Vendor or Destination)   ___________________________________________

and the directors thereof from any and all liability, claims or demands for personal injury, sickness or death, as well as property damages and expenses, of any nature whatsoever which may be incurred by the undersigned and/or the child participant that occur while said is participating in the above described trip or activity.
Furthermore, I (and for or on behalf of my child participant, if under the age of 21 years) hereby assume all risk of personal injury, sickness, death, damage and expense as a result of participation in recreation and work activities involved therein.
Further, authorization and permission is given to said trip and travel organizers to furnish and hereby release liability of transportation, food and lodging for this participant.
The undersigned further hereby agrees to hold harmless and indemnify said organization(s), its directors, employees and agents, for any liability sustained by said travel organizers as the result,of negligent, willful or intentional acts of said participant, including expenses incurred attendant thereto.

(If the participant has not attained the age of 21 years):
I (we) are the parent(s) or legal guardian(s) of this participant, and hereby grant our (my) permission for him/her to participate fully in said event and hereby give our permission to take said participant to a doctor or hospital and hereby authorize medical treatment, including but not limited to emergency surgery or medical treatment, and assume the responsibility of all medical bills, if any/
Further, should it become necessary for the participant to return home due to medical reasons, disciplinary action or otherwise, I (we) hereby assume all transportation costs.

Print name of participant      ____________________________________________

___ Father  ____________________________________________   Date  _____________

___ Mother ____________________________________________   Date   _____________

___ Guardian  ___________________________________________  Date ______________

Trip Participant Only
I have read the above and understand the rules of conduct and will fully abide by them,

as well as all additional instructions of the leadership of this trip, and activity directors.

X ________________________________________________

New York
September 11
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America Remembers
Life Magazine

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