Release And Waiver Of Liability Form - Habitat For Humanity Of Lake-Sumter, Florida printable pdf download

Construction___ Admin___ Committee___ Fundraising___

Leesburg Store ___ Eustis Store ___

Check one

Wildwood Store ___ Groveland Store ___

Habitat for Humanity of Lake-Sumter, Florida

900 Main Street, The Villages, FL 32159 (352)483-0434

IMPORTANT: Each volunteer must have a signed “Release and Waiver of Liability” on file.

Release and Waiver of Liability

IMPORTANT: If the Volunteer is less than 18 years of age, all parents or guardians must

also sign this Release and Waiver of Liability with a witness. Also, all parents or guardians

must complete the “Parental Authorization for Treatment of, and Travel With, a Minor

Child” on the following page. If only one parent or guardian executes this Release on

behalf of a Volunteer who is under 18 years of age, then the undersigned parent or

guardian of the Volunteer hereby covenants, warrants, represents and agrees that he or

she is executing this Release on behalf of, and as an agent for, any other individual who

may be a parent or guardian of the Volunteer, and that by executing this Release, the

undersigned is binding himself/herself, the Volunteer, and any other parent or guardian of

the Volunteer, and all of their heirs, executors, personal representatives, assigns and

estates to this Release.

Parent/Guardian: Name (please print): _______________________ Signature: _________________________

Address: _________________________________________________________________________________________

Witness: Name (please print): __________________________________ Signature: ________________________

Parent/Guardian: Name (please print): ________________________ Signature: ________________________

Address: _________________________________________________________________________________________

Witness: Name (please print): ______________________________ Signature: ____________________________

EMERGENCY CONTACT INFORMATION

Name: __________________________________________ Relationship: ______________________________________

Address: ___________________________________________________________________________________________

Phone: (H) _______________________ (C/W) _______________________ E-mail: _____________________________

IF APPLICABLE:

School/Organization (no abbreviations please):

____________________________________________________________

Church:

____________________________________________________________

Civic Group:

___________________________________________________________

Please complete BOTH sides of waiver

Common Folder/Volunteer Coordination/Standard Waiver Minors and Adults 2012. Updated 7/5/2012

Release And Waiver Of Liability Form - Habitat For Humanity Of Lake-Sumter, Florida