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Georgia State Parks And Historic Sites Registration And Waiver Release Form - Georgia Department Of Natural Resources

Georgia State Parks and Historic Sites Registration and Waiver Release Form

Event:____________________________________________________ Date:_______________

I understand that there are risks of injury or death or damage to property involved in my

participation in such an event, that it is my responsibility to insure the safety of the equipment

used and to see that it is operated properly, and that the Georgia Department of Natural

Resources and its staff and representatives assume no responsibility for the condition of such

equipment, its operations, or safety of the activities involved in this event. In consideration of

the acceptance of this registration by the Department, I waive and release and hold harmless the

Department and its staff and representatives from any and all claims of damages against the

Department and its staff and representatives for injury, or death or damage to property that may

occur as a result of or in connection with this event and agree to pay, protect, indemnify and save

against all liabilities, damages, costs, expenses, causes of action, suits, demands, judgments and

claims of any nature whatsoever arising from, by reason of, or in connection with any injury or

death of persons or damage to property arising from, by reason of or in connection with my

participation in this event.

I further understand that such an event requires all participants to be in good health and without

physical limitations and I certify that I am in good health and have no physical limitations.

Full Name_____________________________________________________________________

Street Address_________________________________________________________________

City _________________________________________ State _______ Zip ________________

Age _________

Please list any medical care or physical conditions that the event coordinators should be aware of

(Examples: diabetic, or special medications).

I have read this entire form, including the statement of good health, acceptance of risk and

waive, release and indemnification provisions. All information I have given is accurate and

correct.

Signature ______________________________________________Date: ___________________

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: ___________________

Georgia State Parks And Historic Sites Registration And Waiver Release Form - Georgia Department Of Natural Resources