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Waiver And Release Form

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WAIVER AND RELEASE FORM

Each student volunteer must have his/her parent or guardian sign this form. Each adult

volunteer is required to complete this form.

Please print clearly.

Attending With: Furman University

Student/Attendee’s Name:

________________________________________

Parent/Guardian’s Name:

_________________________________________

Home Address:

_________________________________________________

City: _________________________State: ____________Zip: ______

Phone: (____)___________

Date of Birth (MM/DD/YYYY): ________

E-Mail: __________________

Please check all that apply.

___Male

___Female ___Student Volunteer ___Adult Volunteer

Being aware of all of the activities sponsored by Central Community

Ministries (CCM), I hereby consent to the attendee’s participation in said

activities. I voluntarily release and forever discharge CCM, its

representatives and its directors from any and all liability, claims, actions,

or rights of action which are in any way related to the attendee’s

participation in CCM’s mission projects. This release is binding on my

heirs, personal representatives, and assigns. I acknowledge that I have

been given the opportunity to ask questions regarding any aspect of this

release and the attendee’s participation with CCM. By signing in the space

provided below, I do acknowledge that I have read completely and fully

understand all aspects of this release form and agree to its terms in its

entirety.

ATTENDEE’S SIGNATURE: _____________________DATE: _________

PARENT/GUARDIAN SIGNATURE (

if attendee is under 18

____________________________ DATE: _____________

Subscribed and sworn before me this_____ day of _____________________,

20___

________________________________

Notary Public Signature and Seal

Waiver And Release Form

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