ORIGINAL Agreement and Release of Liability

Agreement and Release of Liability
I,   First Name*   Last Name*, residing at   Street Address*      City*   State*   Zip*   , County of   County* ,
acknowledge that I have voluntarily applied my student
Student First Name*   Student Last Name*
to participate in the following eventEvent Name* located at   Destination* during the following dates mm/dd-mm/dd* Year of yyyy*organized by Equipt, Inc. DBAChurch name* a Florida not-for-profit corporation (hereinafter referred to as "Equipt").
I am aware of the hazards and risks associated with participation in the {input8:9} trip which include, but are not necessarily limited to, the possibility of death or injury resulting from accident, disease, civil or government unrest, war, terrorist acts, weather conditions, inadequate or contaminated food and water, or inadequate or unavailable medical services or supplies. I am vhttps://form.jotform.com/241484344600047oluntarily enrolling and permitting {input8:4} in the {input8:9} trip with knowledge of the danger involved and assume any and all risks of injury, death, or property damage.

In consideration of being permitted by Equipt to participate in the {input8:9} trip, I agree that I and my heirs, guardians, legal representatives, successors and assigns will not make a claim against, sue, attach the property of, or prosecute Equipt, its directors, officers, employees, agents or servants for any injury, death or property damage occurring to me as a result of my participation in the event/trip, whether caused by the negligence of Equipt, its directors, officers, employees, agents or servants, or any other person, persons or entities. In addition, I release and discharge Equipt, its directors, officers, employees, agents or servants from all actions, claims or demands that I and my heirs, guardians, legal representatives, successors or assigns, now or in the future, may have for any injury, death or property damage resulting as a participant in the {input8:9} trip.

I agree for myself and my heirs, guardians, legal representatives, successors and assigns that in the event any claim for personal injury, death or property damage shall be prosecuted against Equipt, its directors, officers, employees, agents or servants, I shall indemnify and save harmless Equipt, its directors, officers, employees, agents or servants from any and all such claims or causes of action by whomever made and wherever presented.

I have carefully read this Agreement and Release and fully understand its contents. I am aware that this is a release of liability and an indemnification contract between myself and Equipt, its directors, officers, employees, agents or servants, and sign it of my own free will.
Dated this day:*

MonthDayYear
Date
By (Parent or Legal Guardian if applicant is 17 or younger):*

First NameLast Name
Authorized Signer:*

Self (Adult, 18+ years)Parent or legal guardian (For minors)
Signature (Parent or Legal Guardian if applicant is 17 or younger)*

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EQUIPT. INC.

19601 BEN HILL GRIFFIN PKWY. FORT MYERS FL 33913 239-288-0129 I WWW.EQUIPTTEAM.ORG
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Agreement and Release of Liability

EQUIPT. INC.