Registration, General Release Of Liability And Convenant Not To Sue For Minors Form - Georgia Department Of Natural Resources


________________________________________________ Date: _______________
I/We understand that there are risks of injury or death or damage to property involved in my/our child’s
participation in such an event, that it is my/our responsibility to insure that safety of equipment, if used, and to see
that it is operated properly, and that the Georgia Department of Natural Resources and its officers, staff,
representatives and agents assume no responsibility for the condition of such equipment, its operation, or the safety
of the activities involved in this event. In consideration of the acceptance of this registration by the Department and
the benefits derived from my child’s participation in this event, I/We waive, release and covenant not to sue upon
any claim of damages against the Department and its officers, staff, representatives and agents, including, but not
limited to, claims for wrongful death, medical expenses, personal injury and damage to property, that may occur as
the results of my/our child’s participation in this event.
Furthermore, I/We agree to pay, protect, indemnify and save the Department and its officers, staff,
representatives and agents harmless from and against all liabilities, damages, costs, expenses, cause of actions, suits,
demands, judgments, and claims of any nature whatsoever, including, but not limited to any liability the Department
may incur, arising from, by reason of, or in connection with my child’s participation in this event.
I/We further understand that such an event requires all participants to be in good health and without
physical limitations and I/we certify that my/our child is in good health and have no physical limitations.
(Please Print or Type)
CHILD’S NAME:___________________________________________________________ AGE:______________
PARENT’S NAMES:___________________________________________________________________________
STREET ADDRESS:___________________________________________________________________________
HOME NUMBER:____________________________ E-Mail:__________________________________________
Please list any medical care or physical condition we should be aware of:
I/We have read this entire form, including the statement of good health, acceptance of risk and waiver, and release
and indemnification provisions. All information I/we have given is accurate and correct.
Photo/Film Release - Photographs/film may be used of me or my child in publications,
including electronic publications, or in audiovisual presentations, promotional literature,
advertising, or in other similar ways.
Signature_____________________________________________________ Date:____________


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