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Date Posted: 12:49:40 04/08/10 Thu
Author: SS
Subject: ***************ED2010YOUTHWAIVERTEXT**************



Youth Volunteer Waiver
Earth Day 2010

If you are under 18 you must fill out and sign both sides of this release form with your parent or guardian. Minors without signed release forms will not be permitted to participate in any activities.

First Name: _____________ Last Name: _______________________

Address: ______________________________________________________

City: __________________ Zip Code: ___________

Home/Cell Phone Number: __________________

Email: ______________________________________

Age: _____ School or Group Volunteering With: ____________________________


Please read the following agreement and sign below

In connection with my voluntary involvement in activities undertaken for, and with the participation and support of the City Repair Project, a non-profit action organization, I hereby agree, for myself, my heirs, assigns, executors, and administrators to release and discharge the City Repair Project, its officers, coordinators, administrators and volunteers from all claims, demands, and actions for injuries sustained to my person and/or property as a result of my involvement in such activities, whether or not resulting from negligence, and I agree to release and hold the City Repair Project, its officers, coordinators, administrators and volunteers harmless from any cause of action, claim, or suit arising there from. I hereby attest that my attendance and involvement in such activities is voluntary, that I am participating at my own risk, and that I have read the foregoing terms and conditions of this release.


__________________________ _____________________________
Signature of Volunteer Parent/Legal Guardian Signature


The City Repair Project – 1131 SE Oak Street / PO Box 42615, Portland, OR 97242 – (503) 235-8946

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