Cobb County School District "Blanket" Permission To Participate Form/medical History Permission And Release Form/etc. Page 6
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7NW Metro Atlanta Habitat for Humanity
and from the work sites; and exposure to lead, asbestos, and mold, which may cause or worsen certain
illnesses, especially if I do not wear protective equipment, am exposed for extended periods of time, or have a
pre-existing immune system deficiency.
I also understand there is some inherent risk in consuming local foods and living in local accommodations in
the city(ies) or country(ies) visited. I further understand I may be traveling to and from locations where there
is a risk of terrorism, war, insurrection, criminal activities, inclement weather or other circumstances that
could threaten my health or safety. I also understand that it is the policy of the Released Parties to not pay
ransom or make any other payments to secure the release of hostages.
I hereby expressly and specifically assume the risk of injury or harm in the Activities and release the Released
Parties from all liability for any loss, cost, expense, injury, illness, death or property damage resulting directly
or indirectly from the Activities.
Insurance. I, the Volunteer, understand that, except as otherwise agreed to by the Released Parties in
writing, the Released Parties are under no obligation to provide, carry or maintain health, medical, travel,
disability or other insurance coverage for any Volunteer. Each Volunteer is expected and encouraged to obtain
his or her own health, medical, travel, disability or other insurance coverage.
Photographic Release. I, the Volunteer, do hereby grant and convey unto Habitat for Humanity
International, Inc., all right, title and interest in any and all photographs and video or audio recordings of or
including my image or voice, made by any of the Released Parties during my Activities with the Released
Parties, including, but not limited to, the right to use such photographs or recordings for any purpose and to
any royalties, proceeds or other benefits derived from them.
Other. I, the Volunteer, expressly agree that this Release is intended to be as broad and inclusive as
permitted by the laws of the state where the Activities take place. I further agree that in the event any clause
or provision of this Release shall be held to be invalid by any court of competent jurisdiction, the invalidity of
such clause or provision shall not otherwise affect the remaining clauses or provisions of this Release, which
shall continue to be enforceable. Further, a waiver of a right under this Release does not prevent the exercise
of any other right.
To express my understanding of and agreement with this Release, I sign here with a witness.
Volunteer: Name (please print): __________________________ Signature: _________________________________
Address: _____________________________________________________________________________________________
Phone: (H) _________________ (C) ________________ E-mail: ________________ Date of Birth: _________________
Witness: Name (please print): ___________________________ Signature: ___________________________________
EMERGENCY CONTACT INFORMATION
Name: __________________________________________ Relationship: ______________________________________
Address: ___________________________________________________________________________________________
Phone: (H) _______________________ (C/W) _______________________ E-mail: _____________________________
Page 6 of 7
Waiver/Release Form v4.2014
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