Liability Release Form - Adults printable pdf download

Liability Release Form – Adults

Release of All Claims

On this _______ day of ______ 2014, I, ____________________________________agree to participate

in the selling of fireworks and/or any other fundraising activities. This will occur at premises of 106

Elm, Jenks OK 74037 and other location(s) necessary for this fundraiser. The duration period of: June

26th – July 6, 2014. I release the product provider Tork Investments (dba Big Blast Fireworks) of any and

all liability for omissions or commissions while I work and or volunteer with or for the Group known as:

Jenks Band Parents & Jenks Trojan Pride.

In case of emergency, illness or accident, I may be given first-aid and then the contact person(s) notified.

If the contact person(s) cannot be located, I give my permission to be taken to the nearest doctor or

emergency room.

Jenks Band Parents & Jenks Trojan Pride, Tork Investments (dba Big Blast

(Group name)

Fireworks) its directors, employees and/or agents do not assume responsibility for the payment of

hospital, medical, doctor and/or ambulance fees.

I am fully aware TI has no role in this situation and therefore release TI, its directors, employees and or

agents of any and all liability and that TI will not assume responsibility for any consequences and the

payment of any fees or judgments.

Person to contact in case of emergency: _______________________________________

Insurance Information: ____________________________________________________

Medical Alert Information: _________________________________________________

_______________________________________________________________________

Hospital of Choice: _______________________________________________________

Physician: _____________________________Telephone No.:_____________________

Contact Person #1 ______________________________Relationship:

______________________

(PRINT Name)

Work #______________Home #_________________ Cell # _________________Other:______________

Contact Person #2 ______________________________Relationship:

______________________

(PRINT Name)

Work #______________Home #_________________ Cell # _________________Other:______________

Volunteer Signature:

________________________________________________________________

Note: No one will be permitted to work or volunteer without this form filled out on file with the Group and a copy turned

into TI.

Liability Release Form - Adults