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Waiver of Liability The Undersigned, desiring to participate in the activities, programs, and ministries promoted and/or facilitated by or through Club Dust Inc., hereby agrees to assume any and all liability for the undersigned’s acts or missions in the course of the activity participated in by the undersigned, and further relieves Club Dust Inc., its officers, Board of Directors, agents, and any and all other persons associated with or operating through Club Dust Inc. of and from any and all liability for injuries occurring in the Continental United States or outside of the Continental United States, and agrees to indemnify and hold Club Dust Inc., its officers, Board of Directors, and agents harmless for any and all damages or injuries which may be caused by the undersigned in the course of participating in activities sponsored, promoted, or participated in by Club Dust Inc.. The undersigned understands that these waivers and releases herein cover each and every member of the undersigned’s family and that the undersigned’s agreement in these waivers and releases is a precondition to the undersigned’s participation in activities sponsored, promoted, or participated in by Club Dust Inc.. Date of missionary trip to Tecate, Mexico: Saturday 5 PM December 27, 2008 to Wednesday noon December 31, 2008 Date: ___________________________________________ Signature:_______________________________________ Print Name:_____________________________________ Date of Birth:________________ Age:________________ If Minor under the age of 18 years of age please fill out the following: I hereby give permission for ____________________________ to participate in the missions trip to Tecate, Mexico organized by Club Dust from Wednesday evening June 25, 2008 to Sunday noon June 29, 2008 I give permission to ____________________________ or any of the Club Dust leaders to act on my behalf concerning any medical emergency involving my child until I can be notified by reasonable means. Parent Signature:________________________ Print Name:____________________________ Date:_________________________________ Age:_________________________________ |
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