|
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
________________________________________________
|