LIABILIY RELEASE WAIVER
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Name
First Name
Last Name
Email
example@example.com
Emergency Contact
Example - Name ; phone number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
I hereby acknowledge that I have carefully read and fully understand the terms and conditions outlined in the attached waiver. By choosing "YES" and signing below, I voluntarily agree to be legally bound by its provisions. I expressly waive, release, and discharge Pocahontas Trails and SHARC, including their officers, directors, employees, volunteers, agents, and affiliates, from any and all liability, claims, demands, actions, or causes of action arising out of or related to any injury, loss, or damage I may sustain while participating in any activities organized, sponsored, or affiliated with Pocahontas Trails/SHARC, whether caused by negligence or otherwise. I affirm that this release is binding upon me, my heirs, executors, administrators, and assigns.
Please Select
YES
NO
Signature
Date
-
Month
-
Day
Year
Date
Submit
Submit
Should be Empty: