Lighthouse Homeschoolers Inc.
Name ________________________________________ (Releaser) DOB________________
City _________________________ State __________ Zip Code _________________
Home Phone ___________________ School/Work Phone ____________________
In case of emergency, please contact: _________________________Phone: ____________________
I, _____________________, (Releaser) hereby agree that upon acceptance into Lighthouse Homeschoolers Inc., I sincerely pledge to obey all rules and regulations of Lighthouse Homeschoolers Inc., which are set up for the purpose of keeping order and for the protection of the members from injury. I recognize that a risk of injury is involved in many activities and that my adherence to these rules and instructor’s direction and instruction is required.
In consideration of being permitted to participate in Lighthouse Homeschoolers Inc. activities, including but not limited to attending classes, attending field trips, attending group activities, attending play dates or participation in anyway, the undersigned, for himself/herself, any personal representatives, heirs and next of kin, hereby acknowledges, agrees and represents the following:
1. The undersigned hereby releases, waives, discharges and covenants not to sue Lighthouse Homeschoolers Inc., its directors, officers, volunteers, agents, members, instructors and authorized guest instructor(s) (hereinafter referred to as the “Releasees”) from all liability to the undersigned, his/her personal representatives, assigns, heirs and next of kin for any loss, damage, and any claim or demands therefore on account of injury to the person or property or resulting in injury or death of the undersigned, whether caused by the negligence of the Releasees or otherwise while the undersigned is participating in any of Lighthouse Homeschoolers Inc. activities;
2. The undersigned hereby agrees to indemnify and save and hold harmless the Releasees from any loss, liability, damage or costs they may incur due to the undersigned participation in Lighthouse Homeschoolers Inc. activities whether caused by the negligence of the Releasees or otherwise against all liability claims, judgments or demands from damages arising from accidents or injuries of the undersigned;
3. The undersigned hereby assumes full responsibility for and risk of bodily injury, death, or property damage due to the negligence of the Releasees or otherwise while participating in any of Lighthouse Homeschoolers Inc. activities;
4. The undersigned does not and will not expect Lighthouse Homeschoolers Inc. to pay for any medical bills or any expenses of any kind as a result of the Releaser participation in any Lighthouse Homeschoolers Inc. activity; and
5. The undersigned hereby acknowledges that their participation in any Lighthouse Homeschoolers Inc. activity is on a voluntary basis and no promises or guarantees have been made to the undersigned Releaser
THE UNDERSIGNED further expressly agrees that the foregoing RELEASE AND WAIVER OF LIABILITY AGREEMENT is intended to be as broad and as inclusive as permitted by the laws of the State of Florida and if that any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force in effect. The undersigned has read and voluntarily signs this release and waiver of liability agreement and further agrees that no oral representations, statements or inducement apart from the foregoing written agreement have been made.
Parent/Guardian Signature Date