waiver-of-liability-spirits-of-the-forest-2019

WAIVER OF LIABILTY You agree not to hold Indiana Association of Spiritualists, its instructors and its volunteers liable for any injury, loss, damage, claim, or death to your child as a result of any deliberate or unintentional action or inaction, or negligence on any part. You understand and agree that if your child suffers any injury of any kind, you are solely responsible for any and all medical costs incurred as a result of any injuries or claims incurred as a result of, or claimed from Indiana Association of Spiritualists. You, on behalf of yourself, and any minor children, and on behalf of your assigns, heirs, or executors, do hereby waive any and all claims, losses, damages, and/or suits of any nature, related to this activity, against The Indiana Association of Spiritualists, or any representative thereof. YOU HAVE READ THE FOREGOING AND INTENTIONALLY AND VOLUNTARILY SIGN THIS RELEASE AND WAIVER OF LIABILITY AGREEMENT FOR BOTH YOU AND YOUR MINOR CHILDREN. _____________________________________________________ Parent/ Guardian (Print Full Name) _____________________________________________________ Name of Minor Child(ren) (if any) _____________________________________________________ Signature Date PERMISSION TO USE PHOTOGRAPH I (I do not___________ ) grant the Indiana Association of Spiritualists the right to take photographs of me and my family in connection with the organization.

I authorize the Indiana Association of Spiritualists, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that the Indiana Association of Spiritualists may use such photographs of me for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. I HAVE READ AND UNDERSTAND THE ABOVE: Signature _____________________________________________________ Printed name ___________________________________________________ Address________________________________________________________ Date__________________________________________________________ Signature, parent or guardian ______________________________________ (if under age 18) CHILD(REN) INFORMATION Child’s Name_________________________________________Date of Birth__________________ Child’s Name_________________________________________Date of Birth__________________ Child’s Name_________________________________________Date of Birth__________________ Home Address_____________________________________________________________________ Mailing Address____________________________________________________________________ Telephone(s) Home____________________________ Mother/Guardian’s cell__________________ Father/Guardian’s cell___________________ Mother/Guardian’s Name:____________________________________________________________ Email address________________________________________________________________ Father/Guardian’s Name:_____________________________________________________________ Email address________________________________________________________________ EMERGENCY CONTACT: ___________________________________________________________ Siblings --- Names and Ages___________________________________________________________ Allergies (food/ environmental)_________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ Special Needs (learning, developmental, motor, fears, aversions)_______________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ Other concerns _______________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________