Sep
07
Participation Release Form
Please print and make enough copies for each participant to complete one.
Community Servants, Inc. & Wherry Housing Cooperative
Participation Release
Name __________________________________
Address_________________________________Phone#______________________
City______________ST_____ZIP____________
In consideration of being allowed to participate in the mission trip to Wherry Housing and in consideration of the benefits to be derived there from, I hereby release Community Servants, Inc., Wherry Housing Cooperative and their present and former trustees, officers, employees, agents and their heirs, administrators, executors, successors, and assigns from all claims and liabilities of any kind, whether known or unknown, which arise from or are connected in any way with my participation in the trip.
I recognize that the conditions in some of the places to which my child or I will travel are not of the same standard as the conditions to which I am accustomed. I realized further that there are certain health risks as well as other risks to my property and me, and I enter into participation in this trip with knowledge of those risks.
I certify that I am of lawful age and competent to sign this Release, and have done so voluntarily.
I understand that his document constitutes a full and complete waiver of all possible claims for any act or omission, including claims for negligence regarding injury or property, arising out of my participation in the trip.
I understand that this Release applies to, covers, and includes unknown, unforeseen, unanticipated and unsuspected damages, losses, or liabilities and the consequences thereof, which result from the matters hereinbefore inferred to as well as those now disclosed and known to exist. The provision of any state, federal, local or territorial law or stature providing in substance that releases shall not extend to claims of damages which are unknown or unsuspected to exist at the time are hereby expressly waived by me.
Participant's Signature_______________________ Date __________
Parent or Guardian Signature__________________ Date___________
( must be notarized)
NOTARY_________________________________ Date___________
Please print and make enough copies for each participant to complete one.
Community Servants, Inc. & Wherry Housing Cooperative
Participation Release
Name __________________________________
Address_________________________________Phone#______________________
City______________ST_____ZIP____________
In consideration of being allowed to participate in the mission trip to Wherry Housing and in consideration of the benefits to be derived there from, I hereby release Community Servants, Inc., Wherry Housing Cooperative and their present and former trustees, officers, employees, agents and their heirs, administrators, executors, successors, and assigns from all claims and liabilities of any kind, whether known or unknown, which arise from or are connected in any way with my participation in the trip.
I recognize that the conditions in some of the places to which my child or I will travel are not of the same standard as the conditions to which I am accustomed. I realized further that there are certain health risks as well as other risks to my property and me, and I enter into participation in this trip with knowledge of those risks.
I certify that I am of lawful age and competent to sign this Release, and have done so voluntarily.
I understand that his document constitutes a full and complete waiver of all possible claims for any act or omission, including claims for negligence regarding injury or property, arising out of my participation in the trip.
I understand that this Release applies to, covers, and includes unknown, unforeseen, unanticipated and unsuspected damages, losses, or liabilities and the consequences thereof, which result from the matters hereinbefore inferred to as well as those now disclosed and known to exist. The provision of any state, federal, local or territorial law or stature providing in substance that releases shall not extend to claims of damages which are unknown or unsuspected to exist at the time are hereby expressly waived by me.
Participant's Signature_______________________ Date __________
Parent or Guardian Signature__________________ Date___________
( must be notarized)
NOTARY_________________________________ Date___________