SILICON VALLEY FUTURE STARS ACTIVITIES
"A community that values its young ... invests in their future."
Login

Newsletter
Please login if you are a registered user.


Lists:
Action:
Future Stars Activities      Print Offline Registration      Limited Liability Form

Limited Liability

I am aware that during any trip or excursion injury or death may occur from hazards, including but not limited to, hazards of accidents or illness in places without medical facilities, hazards created by the forces of nature, and hazards of travel by air, train, bus, automobile and walking. I am voluntarily permitting Participant to participate in the above activity with the knowledge of the damages involved and I agree to accept any and all risks of injury or death.

Parent/Guardian please initial here: ______________________

In consideration of Participant’s participation in the activity described above, I agree that I, my heirs, spouse, guardians, legal representatives, and assigns will not make a claim against, or sue Silicon Valley African Productions, its officers, agents, or employees for injury, death or property damages arising from Participant’s participation in the activity described above.

In addition, I release and discharge the Silicon Valley African Productions, its officers, agents and employees from all actions, claims, or demands that I, my heirs, guardians, legal representatives or assigns now have or may later have for injury, death or property damage resulting from Participant’s participation in the activity described above.

This Agreement and Release of Liability are intended to be binding upon heirs, guardians, legal representatives, and assigns.

I, ________________________________________ (Parent/Guardian), HAVE CAREFULLY READ THIS DOCUMENT AND FULLY UNDERSTAND ITS CONTENTS. I HAVE EXPLAINED THIS DOCUMENT TO MY CHILD/WARD AND REPRESENT THAT MY CHILD/WARD UNDERSTANDS THE CONTENTS OF THIS DOCUMENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND I SIGN IT VOLUNTARILY.

Parent/Guardian’s Signature             ________________________            Date______________________

If Participant is under the age of 18:

Name of Parent/Legal Guardian: ______________________Email_________________________

Parent/Legal Guardian’s Address: _________________________________________________

Parent/Legal Guardian’s Home Telephone No.: _____________________Work:______________  ____

 
Organization/School/Company:
First Name**:
Last Name**:
Address 1**:
Address 2:
City**:
State / Province**:
Zip**:
Country**:
Phone Number**:
Email Address**:
Status:
 
(** Required Fields)


 
 
 
 
 A Program of Silicon Valley African Productions, Inc. All rights reserved.
Powered by  Learning Right Technologies, LLC