Please enable JavaScript in your browser to complete this form.
Agreement to Electronic Signature (by placing your name below, you confirm that the submission of this form constitutes a legally binding document with your electronically submitted signature)
Waiver Signature. By signing below, you agree to: 1. WAIVER and RELEASE, 2. MEDICAL TREATMENT, 3. ASSUMPTION OF RISK, 4. MEDIA RELEASE, & 5. OTHER as enumerated and explained below.
by the undersigned (the Volunteer) in favor of Church Army USA of Aliquippa, PA, a Pennsylvania not-for-profit corporation (Church Army USA), its directors, officers, and agents. Volunteer does hereby freely, voluntarily, and without duress execute this Release under the following conditions: 1. WAIVER and RELEASE. Volunteer does hereby release and forever discharge and hold harmless Church Army USA and its successors and assigns from any and all liability, claims and demands of whatever kind or nature, whether in law or equity, which arise or may hereafter arise from Volunteer’s participation with Church Army USA. Volunteer understands this Release discharges Church Army USA from any liability or claim that Volunteer may have against Church Army USA with respect to any bodily injury, personal injury, illness, death or property damage or loss that may result from Volunteer’s participation and financial assistance or other assistance, including but not limited to medical, health, or disability insurance. Volunteer is encouraged to have medical or health insurance in effect. 2. MEDICAL TREATMENT. Volunteer does hereby release and forever discharge Church Army USA from any claim whatsoever which arises or may hereafter arise on account of first aid treatment or service rendered in connection with the Volunteer’s participation. 3. ASSUMPTION OF RISK. Volunteer understands that Volunteer’s participation with Church Army USA may include activities that may be hazardous to the Volunteer and that food, tools, supplies, and facilities may be donated to Church Army USA and beyond the control of Church Army USA. Volunteer hereby expressly and specifically assumes the risk of injury or harm in these activities and releases Church Army USA from all liability for injury, illness, death or property damage or loss resulting from the Volunteer’s participation. 4. MEDIA RELEASE. I grant and convey unto Church Army USA all right, title, and interest in any all photographic images and video or audio recordings made by Church Army USA, including, but not limited to, any royalties, proceeds, or other benefits derived from photographs or recordings. 5. OTHER. Volunteer expressly agrees that this Release is intended to be as broad and inclusive as permitted by the laws of the State of Pennsylvania, and that this Release shall be governed by and interpreted in accordance with the laws of the State of Pennsylvania. Volunteer agrees that in the event that any clause of provision of this Release shall be held invalid by any court of any competent jurisdiction, the invalidity of such clause or provision shall not otherwise affect the remaining provisions of this Release which shall continue to be enforceable.