Athlete and non-employee travel waiver of liability and hold harmless all athletes and guests are required to sign a liability waiver form prior to traveling on a katy aquatics sponsored trip. if an athlete or guest is a minor, a parent or legal...
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Eastcentral conference ohio university 2014 you will not be permitted to participate in acdfa without a signed liability waiver form every conference participant must complete, sign, and date this form before participating in any conference...
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Justamere farm/amanda f. leverett valdosta, georgia 31601 agreement for release and waiver of liability the undersigned hereby requests permission for myself or my child to participate in horseback riding activities conducted by amanda leverett...
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Consent, release, and waiver of liability formeach participant and parent/guardian (if under 18) must accept responsibility for thesafety of themselves, their animal and their equipment. nc 4-h, its administrators,agents, volunteers, and/or...
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Seattle mariners fanfest ? zip line 2014 thank you for coming to fanfest at safeco field today! please carefully review the following information and, if you still wish to participate in the zip line attraction after reading this information,...
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Field day application / consent form and liability waiver name of parent or legal guardian: address: phone number: name and age of child: tshirt size: (s,m,l,xl) please circle events of interest: long jump 100 meter dash 4 person relay race...
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Georgia orienteering club annual waiver of liability turn in at any gaoc event or mail to: gaoc c/o shannonhouse 4738 city view dr. forest park ga 30297 release and waiver of liability, assumption of risk, and indemnity agreement (fill out...
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One university plaza: mailstop 0055 cape girardeau, mo 63701 email: operations.nofrills2014 gmail.com waiver form/disclaimer statement i, in consideration of the national association of college and university residence halls, inc., and southeast...
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Release and waiver of liability i , my minor child, or a minor child under my legal guardianship (individually and collectively referred to as participants), intend to participate in one or more of the following programs of variety, the childrens...
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Skirmish waiver name: 1519 state route 903, jim thorpe, pa 18229 first / last address: apt. #: city: state: zip code: e-mail address: receive email specials? yes no recreational activity release of liability, waiver of claims, express
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Waiver and release of liability for lincoln college high school prospect showcase event (for minors) i, , as parent and legal guardian for (hereinafter "player"), have independently investigated the nature of the high school prospect showcase for...
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Q coach q player legal name date of birth mailing address city gender state q male q female zip code e-mail citizenship q u.s. phone q canada q other waiver of liability, release assumption of risk & indemnity agreement it is the purpose of this...
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Waiver of liability statement (for non-contracted provider medicare advantage claim appeals only) enrollee name medicare/hic number provider dates of service pacificsource medicare health plan i hereby waive any right to collect payment from the...
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4350 e. cotton center blvd., bldg. d phoenix, az 85040 602-586-1880 (phone) 1-866-602-1979 (toll-free) waiver of liability statement enrollee name medicare/hic number provider name dates of service mercy maricopa advantage 4350 e cotton center...
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Kids fitness festival of the palm beaches waiver form camp name (if registering with a group/summer camp) participant information first name: last name: date of birth: m.i. age: address: city: state: phone: zip: e-mail: date attending (please...
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