Fill and Sign the Agreement Not Search Form

Release and Agreement not to Sue regarding Youth Conference By signing this waiver, you agree that you may be giving up legal rights and remedies available to you and your family. Read and complete this waiver carefully. If you have any questions, contact an attorney. Child's Name: _________________________________________________________ Parent/Guardian's Name: ________________________________________________ Home Address: ________________________________________________________ Parent/Guardian Emergency Contact Name and Telephone Numbers: Name: _______________________________________________________________ Relationship: _________________________________________________________ Home Phone: _________________________________________________________ Work Phone: _________________________________________________________ Cell Phone: ___________________________________________________________ If Parent/Guardian Unavailable, Alternate Emergency Contact Name and Phone No: Name: _______________________________________________________________ Relationship: _________________________________________________________ Home Phone: _________________________________________________________ Work Phone: _________________________________________________________ Cell Phone: ___________________________________________________________ 1. Nature of the Conference. I understand that the nature of this private conference event, (name of conference), hereinafter referred to as the Conference, sponsored by (name and address of organization) hereinafter referred to as Organization, is as follows: The Conference will be held at ( name of facility) , hereinafter called the Facility , located at (street address, city, county, state, zip code) f rom (date) to (date) . Approximately ( number) young people and adults will attend the Conference. As a condition of using the Facility, the Facility requires the Conference to rely solely on the Facility's security and medical personnel. The Conference will be in session from (time) to (time) on day one, (time) to (time) on day two, and (specify times for remaining days) , excluding breaks for recreational activities. 2. Nature of Risks. I understand that voluntarily traveling to and attending a Conference of this nature may involve certain risks beyond the reasonable control of Organization, its officers, directors, volunteers, and agents in connection with the Conference and the respective officers, directors, volunteers, and agents, and chaperons or representatives associated with the Conference (said Organization its officers, directors, volunteers, and agents in connection with the Conference and the respective officers, directors, volunteers, and agents, and chaperons or representatives associated with the Conference hereinafter called Releasees) , including but not limited to accidents, emergencies, exposure to reckless conduct of other persons, and/or negligence of the Facility's security and medical personnel, and that disclaim any and all responsibility for any such risks. I understand that my child will sometimes be at the Facility site and at other times may be at other places such as hotels or on tourist excursions in or about (name of city) . If during any break in the Conference there may be an opportunity to participate in recreational or other activities away from the Facility, participants do so at their own risk and subject to all terms and conditions set by any recreational or other provider. 3. Waiver of Liability/Indemnification. By signing this waiver, I agree and acknowledge that I may be giving up important legal rights and remedies available to myself, my family, my heirs, successors, and assigns. For value received, I agree on behalf of myself, my child's other parent if known or living, my child named herein, and our heirs, successors, and assigns ( Releasors ) that I assume all risks and waive any liability of any nature whatsoever against and agree to indemnify and hold harmless Releasees with respect to any and all actions, claims or demands that may be made or brought on by any of Releasors against Releasees arising out of or in connection with my child's travel to or attendance at the Conference, or any other activity my child may engage in while in the (city) area. Further, for value received, for any injury to third parties that may arise because of my child's actions or omissions, I agree to hold harmless and defend Releasees with respect to any and all actions, claims, expenses, or demands arising therefrom that may be made or brought against Releasees including but not limited to reasonable attorney's fees and expenses arising in connection therewith. Any dispute under this Agreement shall be required to be resolved by binding arbitration of the parties hereto. If the parties cannot agree on an arbitrator, each party shall select one arbitrator and both arbitrators shall then select a third. The third arbitrator so selected shall arbitrate said dispute. The arbitration shall be governed by the rules of the American Arbitration Association then in force and effect. Witness our signatures this the ______ day of _________________, 20_____. _____________________________ _________________________ Parent or Guardian Youth’s Signature