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WAIVER OF LIABILITY AND ACKNOWLEDGEMENT OF RISKS FOR BUGS, INSECTS, PLANTS, AND WILDLIFE
Every participant must have one of these signed in order to participate. This form includes parental/guardian information and an additional section for Minor participants' information- so that both Guardian and Minor information can be included on one form. This form will remain on file for the current membership year.
Participant Name:
Your answer
Gender:
Date of Birth:
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Street Address:
Your answer
City:
Your answer
State:
Your answer
Zip:
Your answer
Email Address:
Your answer
Home Phone:
Your answer
Cell Phone:
Your answer
Work Phone:
Your answer
Level:
Troop Number:
Your answer
WAIVER OF LIABILITY AND ACKNOWLEDGEMENTS OF RISKS FOR BUGS, INSECTS, PLANTS, AND WILDLIFE (SECTION 2)
For this section you will need to check that you agree after very statement.
The undersigned on behalf of himself/herself, or in his/her capacity as guardian for a minor participating in activities with the Girl Scouts, or on behalf of her Troop; and on behalf of a minor guest’s personal representatives, assigns, heirs, and executors, (collectively a “Guest”) hereby fully and forever releases Girl Scouts of Middle Tennessee, its employees, volunteers, directors, personal representatives, assigns, heirs, and executors (referred to collectively as “Girl Scouts”), from all loss(es) or damage(s) and any and all claims or demands, on account of injury to or death of the Guest caused by, resulting from, or contributed by bugs, insects, dangerous plants, wildlife, pests, and vermin (“Pests”) in connection with Guest’s attendance at events or in traveling to or from a facility of the Girl Scouts (“Activities”). The undersigned further makes the following representations and warranties:
Required
1. Guest is in good physical condition and is able to safely participate in activities with the Girl Scouts;
Required
2. The undersigned and Guest understand that the Girl Scouts provide access to outdoor activities and attempt to maintain the surroundings and grounds of their facilities in a natural state;
Required
3. The undersigned and Guest understand that Pests inhabit the surroundings and grounds of its outdoor facilities, and that such Pests pose a risk to safety;
Required
4. The undersigned and Guest voluntarily seek to expose themselves/Guest to a natural habitat including potential exposure to Pests;
Required
5. The undersigned and Guest understand that the Girl Scouts are not responsible for injuries, harm, inconvenience, or inconvenience associated with Pests;
Required
6. All statements made herein are true and correct and understands that the Girl Scouts have relied on them in allowing Guest to participate in Activities;
Required
7. Guest authorizes emergency medical treatment in the event that an emergency exists.
Required
GUEST HAS READ THE FOREGOING AND INTENTIONALLY AND VOLUNTARILY SIGNS THIS RELEASE AND WAIVER OF LIABILITY AGREEMENT
Please type your name here as digital signature:
Your answer
Date of digital signature
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YYYY
Are you signing for a minor?
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