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ACCIDENT WAIVER & RELEASE OF LIABILITY FORM
Volunteer

In consideration for allowing me to volunteer for The Courage Project programs, related events, and activities, I, on behalf of myself, my heirs, assignees, agents, attorneys, predecessors, successors, personal representatives or next of kin (“Releasor”), have read and understood this Waiver and Release and hereby acknowledge and provide my legal consent to the following:

1. I acknowledge and fully understand that I, will be engaging in volunteer activities related to Releasee’s programs and that these activities carry with them the inherent risk of serious injury, including permanent disability and death, from which severe economic loss may result not only from my own actions and/or interactions with other volunteers, participants and/or others, the condition of the premises or any equipment that may be used. Because participating in such activities carries associated risks due to unpredictable conditions in an ever changing and potentially dangerous environment, I hereby waive, release, discharge, indemnify, and hold harmless any claims of liability, damages, causes of actions, suits, proceedings, compensation, aMorney’s fees, costs and expenses and demands against The Courage Project, its affiliates, representative administrators, directors, agents, or employees, other participants, volunteers, sponsoring agencies, sponsors, advertisers, their heirs and if applicable, their owners and lessors of premises used to conduct the activities, all of which are hereinafter referred to as “Releasees,” for risks or events foreseeable, unknown or otherwise unforeseeable to me at this time.

2. I AM VOLUNTARILY PARTICIPATING IN THE ACTIVITIES AND ASSUME ALL THE FOREGOING RISKS AND ACCEPT PERSONAL RESPONSIBILITY FOR THE DAMAGES, COSTS AND EXPENSES FOLLOWING SUCH SERIOUS INJURY, PERMANENT DISABILITY OR DEATH, INCLUDING ECONOMIC DAMAGE OR COST. RELEASOR ASSUMES ALL RISKS RELATED TO THE ACTIVITIES AND ACKNOLWEDGES THAT THE PARTICIPANT HAS NOT BEEN ADVISED AGAINST PARTICIPATION BY ANY THIRD PARTY AND IS IN THE PHYSICAL CONDITION TO PARTICIPATE. IT IS PARTICIPANT’S RESPONSIBILITY TO DETERMINE THE ABILITY OF THE PARTICIPANT TO PARTICIPATE IN THE ACTIVITIES.

3. Having read and understood this Waiver and Release, and knowing the above facts, I hereby release, waive, discharge and covenant not to sue The Courage Project and the other Releasees, from present and future demands, claims, losses or damages of any kind, known or unknown, including injury, death or damage to property, even if caused or alleged to be caused in whole or in part by the negligence or fault of the Releasees or otherwise.

4. I understand that The Courage Project and/or the other Releasees may want to take photographs of me and use and reuse these photographs as The Courage Project deems appropriate in its sole discretion. Accordingly, I hereby grant to The Courage Project the unrestricted right to utilize any photographs or images, in whole or in part, in any manner, for any purpose and in any medium now known or hereinafter invented. This right includes, but is not limited to, the right to publish, copy, distribute, alter and publicly display these photographs for editorial, trade or advertising purposes. I understand that I will not receive any money for any use described above and I hereby waive any financial claim or rights pursuant to any such use. I further waive any right to inspect or approve of the exact nature and use of the photographs. I release and discharge The Courage Project from any and all claims and demands arising out of or in connection with any use of the images described above, including any and all claims for libel, defamation and invasion of privacy and/or publicity, and from any and all claims and demands arising by virtue of any blurring, distortion, alteration, optical illusion or digital enhancement, whether intentional or otherwise, that may occur or be produced in the publication of the images. I realize I cannot withdraw my consent after I sign this form, and I realize this form is binding on me and my heirs, legal representatives and assigns.

5. I understand that the Releasee’s programs do not constitute the practice of psychology, medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed by the provision of these programs. In addition, I will not represent or make any claims that can be interpreted otherwise when volunteering.

I HAVE READ THE ABOVE WAIVER AND RELEASE, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, HAVE NOT CHANGED IT ORALLY, AND SIGN IT VOLUNTARILY.

BY SIGNING HERE I AGREE TO THE ABOVE STATED TERMS AND CONDITIONS

Today's Date: September 27, 2020

First Volunteer's Name

First Name*

Last Name*

Phone*
First Volunteer's Date of Birth*
First Volunteer's Signature*
Second Volunteer's Name

First Name*

Last Name*
Second Volunteer's Date of Birth*
Third Volunteer's Name

First Name*

Last Name*
Third Volunteer's Date of Birth*
Fourth Volunteer's Name

First Name*

Last Name*
Fourth Volunteer's Date of Birth*
Fifth Volunteer's Name

First Name*

Last Name*
Fifth Volunteer's Date of Birth*
Sixth Volunteer's Name

First Name*

Last Name*
Sixth Volunteer's Date of Birth*
Seventh Volunteer's Name

First Name*

Last Name*
Seventh Volunteer's Date of Birth*
Eighth Volunteer's Name

First Name*

Last Name*
Eighth Volunteer's Date of Birth*
Ninth Volunteer's Name

First Name*

Last Name*
Ninth Volunteer's Date of Birth*
Tenth Volunteer's Name

First Name*

Last Name*
Tenth Volunteer's Date of Birth*
Volunteer's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
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Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Parent(s) or court-appointed legal guardian(s) must sign for any volunteering minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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