Parent/guardian Consent & Release Of Liability Form For Youth Volunteers printable pdf download

Parent/Guardian Consent & Release of Liability Form for Youth Volunteers

I _____________________________ (name of minor volunteer) acknowledge that I am a participant in St. Anthony

Foundation’s volunteer program. I desire to participate in volunteer “activity” offered by St. Anthony Foundation, and do

so by my own free will.

I recognize that there may be risks or hazards directly or inherently involved in This Activity. With full knowledge of the

facts and circumstances surrounding this Activity, I voluntarily undertake this Activity and assume all responsibility and

risk arising from my participation in this Activity.

I recognize that should I incur a physical injury as a result of my participation in this Activity, my health insurance

coverage will be the first resort for covering any costs related to this injury. If I do not have health insurance coverage, I

understand that St. Anthony Foundation carries an accident insurance policy for volunteers that may cover all or some

of the costs related to this injury. I further acknowledge that my participation in this Activity is NOT covered by worker’s

compensation, and that in the event of an injury I will not be eligible to file a worker’s compensation claim.

I assure St. Anthony Foundation that I have no health related reasons or problems, including but not limited to emotional

sensitivities, that would preclude or restrict my participation in this Activity or that could be aggravated by my

participation in this Activity.

THEREFORE, I release St. Anthony Foundation, it’s trustees, directors, employees, and agents, from any liability

arising out of my participation in this Activity, including, but not limited to any damage to my property or to the property

of others and injury to me or to others, resulting from my negligence or the negligence of others, arising out of or caused

by my participation in this Activity.

The release and waiver is submitted in consideration of St. Anthony Foundation, allowing my voluntary participation in

this Activity. I have read this document in its entirely and I am executing it willfully, with full knowledge of its contents,

and with an understanding of its consequences.

I, the parent/Legal Guardian of the PARTICIPANT, affirm that:

1. I have read and do presently understand the meaning, nature and consequences of consenting to the terms

and conditions of this Release and Waiver of Liability (“Release”), which consists of two (2) pages inclusive of

this page;

2. I sign this Release in full recognition and appreciation of the risks of the above indicated Activity;

3. I am fully competent to sign this Release;

4. I agree to the terms and conditions contained in this Release, and

5. Therefore, I execute this Release for full, adequate, and complete consideration, fully intending for myself, the

PARTICIPANT, and for PARTICIPANT’S family, estate, heirs, administrators, personal representatives, or

assigns to be bound by the terms of this Release.

THIS IS A RELEASE OF LEGAL RIGHTS, READ BOTH PAGES BEFORE SIGNING

I hereby represent that I have carefully read and understand the contents of this document and sign by the

same by my own free will on the date indicated below.

(Minor) PARTICIPANT:

(Print Name)

(Signature and Date)

PARENT OR LEGAL GUARDIAN

(Print Name)

(Emergency Contact/Phone #)

(Signature and Date)

(Email)

Parent/guardian Consent & Release Of Liability Form For Youth Volunteers