Please read this form carefully and be aware that when you or your child participates in any activity of Independence Winter Guard, Inc .or, is chosen as a member for participation in the Independence Winter Guard, Inc. organization, you will be waiving and releasing all claims for injuries you or your minor child/ward might sustain arising out of this program. I recognize and I agree to assume the full risk of any injuries, damages, or loss regardless of severity which I or my minor child/ward may sustain as a result of participating in any and all activities connected with or associated with such program. I agree to waive and relinquish all claims I or my minor child/ward may have as a result of participating in the program against the Independence Winter Guard, Inc. organization, its staff, volunteers, agents, servants, and employees and/or rehearsal/housing institutions. I do hereby fully release and discharge the Independence Winter Guard, its staff, volunteers, agents, servants and employees from any and all claims from injuries, damages or loss which I or my minor child/ward may have or which may accrue to me or my minor child/ward and arising out of, connected with, or in any way associated with the activities of the organization (transportation, rehearsal, housing or otherwise). In the event of an emergency, I authorize the staff of the Independence Winter Guard to secure from any licensed hospital, physician and/or medical personnel any treatment deemed necessary for me or my child/ward’s immediate care and agree that I will be responsible for payment of any and all medical services rendered. I have read and fully understand the above information , warning of risk, assumption of risk, indemnification and waiver and release of all claims and permission to secure treatment.
Photo release: I also grant permission to Independence Winter Guard, Inc. to use any pictures that I or my child/ward may be included in promotion of their programs. This may include photographs, and other likeness or a promotional website.
Print Name ________________________________________________________________
