LIABILITY
RELEASE,
WAIVER & INDEMNITY AGREEMENT
IT IS THE INTENTION OF (Parent
or Guardian)_________________________________
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/bus , AND ITS OFFICERS, AGENTS, OR VOLUNTEERS FROM LIABILITY FOR PROPERTY DAMAGE, OR PERSONAL
INJURY OF (Child's name)
___________________________ CAUSED BY ANY ACT
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 family's auto insurance.)
DATED: ___________________
PARENT OR GUARDIAN : Phone #_____________________Work
#_____________________Cell #_____________________
(Signature) Mother: ___________________________ Father:
________________________Guardian:__________________
(
Print) Mother:__________________________ Father:
_________________________ Guardian:_______________________
Street Address: _____________________________ City:
____________________State:_______ E-Mail ________________
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
- - - - - - - - - - - - - - - - -
(Groups can incorporate
this into their own release, waiver & Liability agreement)
