Liability Waiver for Fall into Girl Scouts

Liability Waiver

Waiver of liability and acknowledgement of risk for bugs, plants, and wildlife.
This waiver is to be used one time for the Fall into Girl Scouts event at Camp Sycamore Hills on Ocotber 26 2024. Attendance at any other property or program will require a new waiver to be completed.
Name*

First NameLast Name
Gender*

MaleFemalePrefer Not to Say
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Preferred Phone Number*
Please enter a valid phone number.
Troop Number
The undersigned on behalf of himself/herself, or in his/her capacity as guardian for a minor participating in activities with the Girl Scouts, or on behalf of her Troop; and on behalf of a minor guest’s personal representatives, assigns, heirs, and executors, (collectively a “Guest”) hereby fully and forever releases Girl Scouts of Middle Tennessee, its employees, volunteers, directors, personal representatives, assigns, heirs, and executors (referred to collectively as “Girl Scouts”), from all loss(es) or damage(s) and any and all claims or demands, on account of injury to or death of the Guest caused by, resulting from, or contributed by bugs, insects, dangerous plants, wildlife, pests, and vermin (“Pests”) in connection with Guest’s attendance at events or in traveling to or from a facility of the Girl Scouts (“Activities”). The undersigned further makes the following representations and warranties.
By selecting below Guest has intentionally and voluntarily signed this release and waiver of liability agreement.

Guest is in good physical condition and is able to safely participate in activities with the Girl Scouts;The undersigned and Guest understand that the Girl Scouts provide access to outdoor activities and attempt to maintain the surroundings and grounds of their facilities in a natural state;The undersigned and Guest understand that Pests inhabit the surroundings and grounds of its outdoor facilities, and that such Pests pose a risk to safetyThe undersigned and Guest voluntarily seek to expose themselves/Guest to a natural habitat including potential exposure to Pests;The undersigned and Guest understand that the Girl Scouts are not responsible for injuries, harm, inconvenience, or inconvenience associated with PestsAll statements made herein are true and correct and understands that the Girl Scouts have relied on them in allowing Guest to participate in Activities;If Guest is a Troop leader, that Guest has advised her Troop of the presence of PestsGuest authorizes emergency medical treatment in the event that an emergency exists.
For a Minor:

The undersigned certifies that (1) Guest is my son, daughter, or other person whom I have legal guardianship over; (2) Guest has my permission to participate in the Activities; and (3) Guest is in good physical condition and is able to safely participate in the Activities. I hereby authorize medical treatment for him/her and grants access to Guest’s medical records as necessary.
Are you signing on behalf of a minor?*

YesNo
Minor Name

First NameLast Name
Minor Name

First NameLast Name
Minor Name

First NameLast Name
Minor Name

First NameLast Name
Signature

Powered by Jotform SignClear
Should be Empty: