LOT Participation Waiver
Leaders of Tomorrow Program - Participation Waiver
Participant's First Name *
Participant's Last Name *
Nickname (if applicable)
Date of Birth *
Address *
City *
State *
Contact Info Home Phone *
Contact Info Mobile Phone *
Contact Info Email *
Parent/Guardian Name *
Medical Conditions *
Waiver and release of all claims and assumption of risk for the Leaders of Tomorrow programs/activities. Please read this form carefully and be aware that in signing up and participating in Leaders of Tomorrow program/activities, you will be expressly assuming the risk and legal liability and waiving and releasing all claims for injuries, damages or loss which you or your minor child/ward might sustain as a result of participating in any and all activities connected with and associated with Leaders of Tomorrow programs/activities (including transportation services/vehicle operation, when provided). I recognize and acknowledge that there may be certain risks involved in participating in programs/activities, and I voluntarily agree to assume the full risk of any injuries, damages or loss, that my minor child/ward or I may sustain as a result of said participation. I further agree to waive and relinquish all claims I or my minor child/ward may have (or accrue to me or my child/ward) as a result of participating in such program/activity against the LOT, including their respective officials, officers, employees, and volunteers (hereinafter collectively referred as “Parties”). I do hereby fully release and forever discharge the Parties from any and all claims for injuries, damages, or loss that my minor child/ward or I may have or which may accrue to me or my minor child/ward and arising out of, connected with, or in any way associated with these programs/activities. I indemnify and hold harmless Leaders of Tomorrow, any of its employees and/or agents from any and all claims from my use of LOT property or participation in any programs. I will further indemnify and “hold harmless” LOT, its employees and/or agents from all costs, expenses and liabilities resulting from any claim brought from my child’s/children’s use of LOT property and/or participation in programs to the extent of the LOT’s liability under general law. This is to certify that I,as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above and, for myself, my heirs, assigns, and my minor child’s involvement or participation in the program as provided above.

I hereby grant permission for myself or my child to be photographed or recorded in connection with any Leaders of Tomorrow promotion. I understand that any photographs or other types of media production may be used for promotional purposes and shown to the general public.
Waiver Agreement *
Electronic Signature Acknowledgement
By signing below, I acknowledge I have read and fully understand the above important information, warning of risk, assumption of risk and waiver and release of all claims.
E-Signature - (Under 18 years of age, the parent/guardian must sign) *
E-Signature Date *
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