Waiver


[PDF]Waiver - Rackcdn.comhttps://3665426f4cf0689b41cd-3c5a81d9531f5025b644972031b2482a.ssl.cf2.rackc...

0 downloads 119 Views 469KB Size

THE COMPTON INITIATIVE

CLEAN-UP DAY PARENTAL CONSENT, RELEASE OF LIABILITY AND PERMISSION TO BE PHOTOGRAPHED/TAPED I, ____________________________________________________ (please print parent’s name) agree to allow _________________________________________________ (please print child’s name), to volunteer for The Compton Initiative’s Clean-Up Day program. I understand that my child’s participation in the Clean-Up Day program is purely voluntary, without any expectation of payment or remuneration of any type, and he or she will not be covered under The Compton Initiative’s or Emmanuel Reform Church's ("ERC") or Adrian Court Productions, Inc. ("ACP") workers’ compensation insurance policy. I hereby certify that my child is medically fit to perform the types of physical activities associated with the Clean-Up Day program. If there is any question regarding my child’s medical fitness, I agree to seek a medical consultation before I he or she participates in the Clean-Up Day program. I hereby fully release and discharge The Compton Initiative, ERC, and ACP, their respective employees, property owners and other volunteers from any injuries or losses my child may suffer that are related in any way to his or her volunteering for the Clean-Up Day program. I fully understand this document, and I am aware that this is a release of liability and that I am GIVING UP MY RIGHT TO SUE THE COMPTON INITIATIVE OR ERC OR ACP, their respective employees, property owners or other volunteers for any injury or loss suffered by my child as a result of his or her participation in the CleanUp Day Program. I also give full permission for representatives of AEP, The Compton Initiative and/or ERC in Paramount, California to capture video, audio, still images or any other personal identification characteristics of my child to be used in any manner, throughout the universe, in perpetuity, in any and all media, now known or hereafter devised, including the right to edit, delete, dub and/or fictionalize such materials. I waive any and all rights to compensation and ownership of such materials or to restrict usage of such materials. Signature ____________________________________________________ Parent or Legal Guardian Signature

_______________________ Date

Parent/Guardian’s Address: __________________________________________________________________ City State Zip Parent/Guardian’s Telephone No.: ____________________________________________________________ Parent/Guardian’s e-mail: ___________________________________________________________________ Second Emergency Contact: _________________________________ Name

_____________________________ Telephone No.

Organization: (i.e. Saddleback Church) _________________________________________________________ Compton Initiative Parental Consent and Release of Liability.docCompton Initiative Parental Consent and Release of Liability

THE COMPTON INITIATIVE

CLEAN-UP DAY VOLUNTEER RELEASE OF LIABILITY AND PERMISSION TO BE PHOTOGRAPHED/TAPED I, _____________________________, (please print) agree to be a volunteer for The Compton Initiative during its Clean-Up Day program. The Clean-Up Day program gathers church members and other interested participants who wish to volunteer in cleaning up and beautifying areas around the Compton community. Volunteers may be asked to pick up and bag litter and trash, do light gardening work, sweep streets and walkways, paint buildings, and other similar activities. I understand that my participation in the Clean-Up Day program is purely voluntary, without any expectation of payment or remuneration of any type, and I will not be covered under The Compton Initiative’s or Emmanuel Reformed Church's ("ERC") or Adrian Court Productions, Inc. ("ACP") workers’ compensation insurance policy. By signing this Volunteer Release of Liability, I am certifying that I am medically fit to perform the types of physical activities associated with the Clean-Up Day program. If there is any question regarding my medical fitness, I agree to seek medical consultation before I volunteer. I hereby fully release and discharge The Compton Initiative, ERC and ACP, their respective employees, property owners and other volunteers from any injuries or losses I suffer that are related in any way to my volunteering for the Clean-Up Day program. I fully understand this is a RELEASE OF LIABILITY and that I am GIVING UP MY RIGHT TO SUE THE COMPTON INITIATIVE OR ERC 0R ACP, their respective employees, property owners and other volunteers for any injury or losses suffered as a result of my volunteering for the Clean-Up Day Program. I also give full permission for representatives of AEP, ERC or The Compton Initiative in Paramount, California to capture video, audio, still images or any other personal identification characteristics of me to be used in any manner, throughout the universe, in perpetuity, in any and all media, now known or hereafter devised, including the right to edit, delete, dub and/or fictionalize such materials. I waive any and all rights to compensation and ownership of such materials or to restrict usage of such materials.

Name ___________________________________________

______________________________ Date Signature _______________________________________________________________________________ Address: _______________________________________________________________________________ Street City State Zip Telephone No.: ______________________

E-mail: _________________________________________

Emergency Contact: __________________________________ Name

______________________________ Emergency Contact Telephone No.

Organization: (i.e. Saddleback Church) _______________________________________________________ □

I am interested in learning about joining a Lieutenant team (these teams lead the crews at the sites)

Compton Initiatve Volunteer Waiver and Release of Claims.docCompton Initiatve Volunteer Waiver and Release of Claims