CLEAN JORDAN LAKE: SIGNATURE REQUIRED FOR PARTICIPATION BY
PARENTS OR GUARDIANS of Minor for ADDITIONAL INDEMNIFICATION

Minors are defined as 11 or older; younger children are not allowed to participate except when agreed upon in advance for small events in which each child is accompanied by an adult

In consideration of the following (“Minor”) being permitted by CJL to participate as a volunteer in its activities, I the (“Parent / Guardian”) on behalf of me, my heirs, personal representatives and executors, hereby disclaim, release and waive any and all claims against the CJL for personal injuries or damages to property sustained by Minor or any other person arising out of the PROJECT, including claims and damages arising in whole or in part from the negligence or the CJL or its agents.

IT IS MY EXPRESS INTENT TO RELEASE THE CJL FROM ANY AND ALL CLAIMS ARISING FROM MINOR’S PARTICIPATION IN THE PROJECT REGARDLESS OF WHETHER SUCH CLAIMS ARE FOUNDED IN WHOLE OR IN PART UPON ALLEGED NEGLIGENCE OF CJL OR ITS AGENTS.

I verify that my son/daughter is age appropriate to volunteer for this project and I, as parent/guardian of said minor, understand that I/authorized guardian must accompany my son/daughter in order for him/her to volunteer if the child is older than 11 (except when agreed upon by Clean Jordan Lake) and younger than 16 as of date of participation entered in window below. I also understand that I must authorize this release for my son/daughter who is between the ages of 16 and 18 as of date of participation entered in window below though he/she does not need to be accompanied by me or an authorized custodian in order for him/her to volunteer.

I verify that qualified emergency medical personnel, including a physician and staff, are authorized to examine the below-named minor child in the event of injury, and to administer any emergency care or treatment deemed necessary. In the case of a minor child, a reasonable effort will be made to contact the Parent/Legal Guardian prior to any treatment. I agree to be responsible for all necessary charges incurred as a result of any care or treatment rendered pursuant to this authorization.

Date of Participation

MM

DD

YYYY

"Minor" Name

First Name

Last Name

Age Bracket

11-13

14-15

16-17

Under 11 BY SPECIAL PERMISSION ONLY

Photo Release

I hereby consent to and authorize the CJL, its publishers, licensees and assignees, permission to use and reproduce still photographs and/or film footage taken of me (and/or photos taken of my child/children) in whole or in part, with or without names, for editorial, trade or advertising purposes. I also confirm that I waive all claims arising from such use for any additional compensation, damages, and invasion of privacy. Enter your initials below to indicate consent.

Parent / Guardian Name

In signing this release and waiver I am relying wholly upon my own judgment, belief and knowledge. By signing this document, I acknowledge that if anyone is hurt or property is damaged during my participation as a volunteer, I may be found by a court of law to have waived my right to maintain a lawsuit against the CJL on the basis of any claim from which I have released them herein. I have had sufficient opportunity to read this entire document. I read and understand it, and I agree to be bound by its terms. Enter your name below to indicate consent.

First Name

Last Name

Today's Date

MM

DD

YYYY

Emergency Telephone Number

(###)

###

####

If you would prefer to download, print and sign a copy of this waiver, please click here.

CLEAN JORDAN LAKE: SIGNATURE REQUIRED FOR PARTICIPATION BY PARENTS OR GUARDIANS of Minor for ADDITIONAL INDEMNIFICATION

CLEAN JORDAN LAKE: SIGNATURE REQUIRED FOR PARTICIPATION BY
PARENTS OR GUARDIANS of Minor for ADDITIONAL INDEMNIFICATION