Youth Outing.. RELEASE,
WAIVER & INDEMNITY AGREEMENT
IT IS THE INTENTION OF (Adult
participant)_________________________________
BY THIS AGREEMENT TO EXEMPT AND RELIEVE William K. and LaVerne J.
Blickley, doing volunteer work as: Wherever God Wills youth group support
service, with their motor home, AND ITS OFFICERS, AGENTS, OR VOLUNTEERS FROM LIABILITY FOR PROPERTY DAMAGE, WRONGFUL DEATH, OR PERSONAL
INJURY OF (Adult participant)
___________________________ CAUSED BY ANY ACT
OF NEGLIGENCE OF this
volunteer support service AND ITS OFFICERS, AGENTS, OR VOLUNTEERS.
I understand that our church/organization youth group leaders are responsible for
programming, the organization, and the supervision of our group members,
and that our youth group is insured for any personal injury liability.
(Note: Because of Michigan's
no-fault law, any personal medical care required by an auto-accident injury, is paid for by
each individual's auto insurance.)
DATED: ___________________
SIGNATURE: (the adult participant) ________________________________Phone
#______________Work #__________
PRINTED NAME:__________________________________________________________
Cell #________________
Street Address:
________________________________City: _____________________State: _______ E-Mail
______
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