Why a waiver? Several
chapters have had incidents at outings where chapterettes have broken bones,
shattered shoulders and one in
Ontario
had someone drop dead on a bus trip and had no contact information on who the
family of this widow was. Add your chapter name and RHS number
at the top and carry a copy with you on all chapter outings. Cut & paste
this form to print into your word document to print then personalize for your
chapter.
Waiver Release & Indemnity Form
Name:______________________________________________________________________
Address:____________________________________________________________________
___________________________________________________________________________
Home Phone: 1-250-
______________________ Cell: 1-250- ________________________
Date of Birth:
Month_________________________ Day________ Year________________
In Case of Emergency notify:___________________________________________________
Home Phone: 1-250- ______________________ Cell: 1-250- ________________________
Doctor’s Name * Phone #______________________________________________________
I
___________________________________________________________understand and
agree that my participation in
(please print clearly)
any events, programs, trips or activities organized, operated and
conducted by the Chapter named herein
THE RED HOT DIVAS CHAPTER #47097 OF THE RED HAT SOCIETY
and/or the Red Hat Society and various chapters and members registered
with the Red Hat Society, is conditional upon my execution of this document.
I, the undersigned, agree not to sue and I further agree to indemnify
and save harmless the officers, directors, owners, employees, volunteers and
affiliates of the above mentioned chapter and the Red Hat Society, from all
expenses, fees, liability, and damage award or cost of any type whatsoever
arising from my participation in these events, programs, trips or activities.
I, the undersigned, my heirs, legal representatives, successors or
assigns, hereby release the above mentioned chapter The Red Hot Divas chapter
# 47097 of the Red Hat Society, its officers, directors, owners, employees,
volunteers and affiliates from any and all claims, debts, actions and
liability which may arise, directly or indirectly, from participating in any
or all events, programs, trips or activities, for any loss, injury, death, or
damages, however caused or arising.
I, the undersigned, understand the risks of membership and accept the
terms and conditions which apply to my becoming a member of the above
mentioned chapter.
I have read and understand this waiver, Release and Indemnity. I have
been given the time and opportunity to consult with legal consul before
signing.
Signature:____________________________________
Date:________________________