Minor Waiver 2018
Every participant in Ecomaniacs program under 18 years old must have this waiver completed by a parent or legal guardian prior to participation each year.
Volunteer Name *
Your answer
Volunteer Group/Organization Name *
Your answer
Volunteer Date of Birth *
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DD
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Parent or Guardian Name *
Your answer
Parent or Guardian Email Address *
Your answer
Emergency Contact Name
(If different from above)
Your answer
Emergency Contact Phone Number *
Your answer
VOLUNTEER RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, INDEMNITY AND CONSENT TO MEDICAL TREATMENT *
In consideration for the Volunteer named below being allowed to participate in the Ecomaniacs Program (“Program”) and engage in the activities related to the Program with the group named below, I, as the Parent/Legal Guardian of the Volunteer, hereby, on behalf of my heirs, next of kin, personal representatives and agents, certify, acknowledge and agree to the following: 1. Acknowledge that the Volunteer and I are aware of and appreciate the character and risks of the Program and voluntarily assume the risks associated with participating in the Ecomaniacs Program. We understand that participation in the Program will involve physical activities, exposure to the elements, and other circumstances which may result in personal injuries. We have also been provided the Ecomaniacs Handbook which sets out the guidelines and rules for participation and acknowledge that by participating the Volunteer has agreed to follow them. 2. Waive any claim or cause of action against and release and discharge City of Sioux Falls and Ecomaniacs its officers, employees, agents and assigns from any liability or claim that the individuals listed above may have against City of Sioux Falls and Ecomaniacs and its successors with respect to any injuries to person or property, illness or death, that may result from participation in the Program, to the extent allowed by law including claims of negligence. 3. Understand and acknowledge that City of Sioux Falls and Ecomaniacs do not assume any responsibility for or obligation to provide financial assistance or other assistance, including but not limited to medical, health, or disability insurance in the event of injury or illness as a result of participation in the Program. 4. Agree to indemnify and forever hold harmless City of Sioux Falls and Ecomaniacs against any loss or expense, including reasonable attorneys fees, from any claims, demands or actions that may hereafter be made by any other person arising from participation in the Program. 5. Provide my consent for Volunteer to receive any medical treatment deemed advisable during participation in the Program and do hereby release and forever discharge City of Sioux Falls and Ecomaniacs any claim whatsoever which arises or may hereafter arise on account of any first aid, treatment, or service rendered in connection with the Program. 6. Agree that the release provided in this Release and Waiver is intended to be as broad and inclusive as permitted by law and the Release and Waiver shall be governed by and interpreted in accordance with the laws of the State of South Dakota. I also agree that in the event any clause or provision of this Release and Waiver shall be held to be invalid by any court of competent jurisdiction, the invalidity of such clause shall not otherwise affect the remaining provisions of the Release and Waiver. 7. Give my permission to Ecomaniacs to use photographs or photographic images of Volunteer participating in the Program in official web sites, newsletters and publications and other materials promoting the Program, as well as, grant and convey unto Ecomaniacs all right, title, and interest in any and all photographic images and video or audio recordings made by Ecomaniacs during participation in the Program. 8. Affirm that I have the legal authority to sign this document as the parent or legal guardian of the Volunteer.
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