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ADIRONDACK TRAIL IMPROVEMENT SOCIETY

P.O. Box 565

Keene Valley, NY 12943

ATIS Adult Program Trip Leader Volunteer Release and Waiver of Liability Form

As a volunteer, I am signing this Release and Waiver of Liability (the “release”) which releases Adirondack Trail Improvement Society (ATIS), a nonprofit corporation organized and existing under the laws of the State of New York and each of its directors, officers, employees, and agents from any and all liability while engaging as a volunteer.

I understand that the scope of my relationship with ATIS is limited to a volunteer position and that no compensation is expected in return for services provided by me as a volunteer; that ATIS will not provide any benefits traditionally associated with employment to me; and that I am responsible for my own insurance coverage in the event of personal injury or illness as a result of my volunteer services to ATIS.

1. Waiver and Release: I, the Volunteer, release and forever discharge and hold harmless ATIS and its successors and assigns from any and all liability, claims, and demands of whatever kind of nature, either in law or in equity, which arise or may hereafter arise from the services I provide to ATIS. I understand and acknowledge that this release discharges ATIS from any liability or claim that I may have against ATIS with respect to bodily injury, personal injury, illness, death, or property damage that may result from the services I provide to ATIS or occurring while I am providing volunteer services.

2. Insurance: Further I understand that ATIS does not assume any responsibility for or obligation to provide me with financial or other assistance, including but not limited to medical, health, or disability benefits or workers’ compensation insurance. I expressly waive any such claim for compensation or liability on the part of ATIS beyond what may be offered freely by ATIS in the event of injury or medical expenses incurred by me.

3. Medical Treatment: I hereby release and forever discharge ATIS from any claim whatsoever which arises or may hereafter arise on account of any first-aid treatment or other medical services rendered in connection with an emergency during my tenure as a volunteer with ATIS.

4. Assumption of Risk: I understand that the services I provide to ATIS may include activities that may be hazardous to me. As a volunteer, I hereby expressly assume risk of injury or harm from these activities and release ATIS from all liability.

5. Confidentiality: I understand that as part of performing my duties, I may have access to, see or hear confidential information. I understand and agree that all such information (oral, visual, or written, including both paper and electronic) which I see or to which I have access may not be released, copied, or disclosed, in whole or in part, unless properly authorized by ATIS.

6. Other: As a volunteer, I expressly agree that this release is intended to be as broad and inclusive as permitted by the laws of the State of New York and that this release shall be governed by and interpreted in accordance with the laws of the State of New York. I agree that in the event that any clause or provision of this release is deemed invalid, the enforceability of the remaining provisions of this release shall not be affected.

Additionally, I give ATIS permission and authority to obtain medical aid or treatment in the case of injury including but not limited to performing any first aid or remedial procedure that is deemed necessary or advisable.

I also give permission for the institution to obtain and use any video, film or photographs of me as a participant, which may be used for promotional purposes.

As a volunteer of this organization, I have read and fully understand the above waiver. I also understand that by signing this document, I agree to the information outlined.


Copy and paste the body of your waiver here.

First Volunteer Trip Leader Name

First Name*

Last Name*

Phone*
First Volunteer Trip Leader Age Acknowledgment*
First Volunteer Trip Leader Date of Birth*
I certify that I am 18 years of age or older
First Volunteer Trip Leader Signature*
Second Volunteer Trip Leader Name

First Name*

Last Name*
Second Volunteer Trip Leader Date of Birth*
Third Volunteer Trip Leader Name

First Name*

Last Name*
Third Volunteer Trip Leader Date of Birth*
Fourth Volunteer Trip Leader Name

First Name*

Last Name*
Fourth Volunteer Trip Leader Date of Birth*
Fifth Volunteer Trip Leader Name

First Name*

Last Name*
Fifth Volunteer Trip Leader Date of Birth*
Sixth Volunteer Trip Leader Name

First Name*

Last Name*
Sixth Volunteer Trip Leader Date of Birth*
Seventh Volunteer Trip Leader Name

First Name*

Last Name*
Seventh Volunteer Trip Leader Date of Birth*
Eighth Volunteer Trip Leader Name

First Name*

Last Name*
Eighth Volunteer Trip Leader Date of Birth*
Ninth Volunteer Trip Leader Name

First Name*

Last Name*
Ninth Volunteer Trip Leader Date of Birth*
Tenth Volunteer Trip Leader Name

First Name*

Last Name*
Tenth Volunteer Trip Leader Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
Volunteer Trip Leader 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(s) or Court-Appointed Legal Guardian(s) must sign for any participating 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.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also 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 Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
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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