R2B child waiver 2015 .pdf

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Original filename: R2B child waiver_2015.pdf
Author: Kevin Klicman

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General Agreement, Waiver, AND Release Form of Liability for
CHILDREN UNDER 18 YEARS OF AGE
Activity: Camp Marston Tree Planting Event on April 18, 2015

Parent or Legal Guardian Name: (print)
Child/Participant’s Name (print)

DOB

Address

City

E-mail

/

Zip

Phone

Emergency Contact Name
Emergency Contact Number (

State

/

Relationship
)

* READ BEFORE SIGNING*
WAIVER AND RELEASE OF LIABILITY FOR CHILDREN UNDER 18 YEARS OF AGE
I HEREBY RELEASE AND HOLD HARMLESS Precision and Root2Branch, and any and all related entities,
officers, directors, employees, other participants sponsoring agencies, sponsors, advertisers, and, if applicable,
owners and lesser of premises used to conduct the event (“Releases”), WITH RESPECT TO ANY AND ALL
INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE
NEGLIGENCE OF THE RELEASES OR OTHERWISE.
I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING
FROM THE NEGLIGENCE OF THE RELEASES or others, and assume full responsibility for my participation.
If however, I observe any unusual significant hazard during my child’s presence or participation, I will remove my
child from participation and bring such to the attention of the nearest Precision/Root2Branch team leader
immediately. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT,
FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS
BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
In consideration of being allowed to participate in the Camp Marston Tree Planting Event on April 18, 2015, related
event, this is to certify that I, as parent or (legal guardian) am legally responsible for this participant, and do consent
and agree to his/her release as provided above, and, for myself, my heirs, assigns, and next of kin, HEREBY
RELEASE and agree to indemnify, hold harmless Precision/Root2Branch from any and all liabilities and incidents
from my minor child’s involvement or participation in this program as provided above. EVEN IF ARISING FROM
THE NEGLIGENCE OF THE RELEASE OR OTHERWISE, to the fullest extent permitted by law.
I give Precision/Root2Branch permission to use my child’s photo and/or likeness on their websites,
and/or for media purposes.
Initials
Parent (legal guardian) Name (PRINT Legibly)
Parent (legal guardian) Name (Signature)

Date


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