WAIVER AND RELEASE OF LIABILITY
I hereby certify that I am the parent or legal guardian of the student
named in this application and that he/she has my permission to be transported
by the Huntsville Inner City Learning Center vehicle. I understand that non-employee
volunteers may provide transportation and I consent to my child being
transports by persons who are not employees of the HICLC. I hereby release
Huntsville Inner City Learning Center, its employees and such volunteers from
any liability arising out of any accident or injury which may occur on the
trip.
If medical care is required while attending the Huntsville Inner City
Inner City Learning Center, I authorize HICLC through its employees or agent to
contact the doctor on record or if that was not possible, I authorize
HICLC through its employees or agents to take son/daughter to the nearest
medical facility for purposes of receiving medical care with the understanding
that I will not hold Huntsville Inner City Learning Center, or its employees of
the medical facility and that I will assume any or all responsibility for
payment for same. On behalf of myself and minor son/daughter, I hereby release
Huntsville Inner City Learning Center and its officers, agents, employees,
successors, and assigns from any and all liability out of or in any way related
to the incident.
Educational Records Permission
I give permission to the Huntsville Inner City Learning Center to view
information pertinent to the success of my child in this program. This
information includes but is not limited to report cards, progress reports,
State test scores and National Standardized Test scores. I also give the HICLC
permission to speak to my child's teachers about homework or missed
assignments. This permission is granted to any person who identifies themselves
as a staff member of the Huntsville Inner City Learning Center.
Photograph Permission
I provide permission for my child to be photographed while attending
functions with the HICLC. I understand that the photos may be used for
promotional purposes either in print or on the internet. I also understand that
the HICLC would never use the photos in a negative manner and would be
concerned with would be concerned with the safety of my child.
Field Trip Permission
I understand that a part of the HICLC program is to go on field trips. I
give my child permission to attend with the understanding that the HICLC will
notify me if the time frame of the trip is beyond 6:00 pm. I will not hold
HICLC liable for any accidents that occur.
WAIVER AND RELEASE OF LIABILITY
This Release and Waiver of
Liability (the "Release") executed on this the Day, the Volunteer in
favor of the Huntsville Inner City Learning Center, a non-profit corporation,
their directors, officers, employees, and agents (collectively, HICLC). The
Volunteer desires to serve as an unpaid volunteer for HICLC and engage in the
activities related to being a volunteer (the "Activities"). The
Volunteer understands that the Activities may include constructing and
rehabilitating buildings &/or working in other HICLC sponsored Activities.
The Volunteer hereby freely, voluntarily, and without duress executes this
Release under the following terms:
RELEASE
AND WAIVER: Volunteer does hereby release and forever discharge and hold
harmless HICLC and its successors and assigns from any and all liability,
claims, and demands of whatever kind or nature, either in law or in equity,
which arise from Volunteer's Activities with HICLC. Volunteer understands that
this Release discharges HICLC from any liability or claim that the Volunteer
may have against HICLC with respect to any bodily injury, personal injury,
illness, death, or property damage that may result from Volunteer's Activities with HICLC, whether caused by the
negligence of HICLC or its officers, directors, employees, or agents or otherwise. Volunteer also
understands that HICLC does not assume any responsibility for or obligation to
provide financial assistance or other assistance, including but not limited to
medical, health, or disability insurance
in the event of injury or illness
MEDICAL
TREATMENT: Volunteer does hereby release and forever discharge HICLC from any
claim whatsoever which arises or may hereafter arise on account of any first
aid, treatment, or service rendered in connection with Volunteer's Activities
with HICLC.
ASSUMPTION OF RISK: The
Volunteer understands that the Activities include work that may be hazardous to
the Volunteer, including, but not limited to, construction, loading and
unloading, and transportation to and from the work sites. Volunteer hereby
expressly and specifically assumes the risk of injury or harm in the Activities
and releases HICLC from all liability for injury, illness, death or property
damage resulting from the Activities.
INSURANCE:
The Volunteer understands that, except as otherwise agreed to by HICLC in
writing, HICLC does not carry or maintain health, medical, or disability
insurance coverage for any Volunteer. Each Volunteer is expected and encouraged
to obtain his or her own medical or health insurance coverage.
PHOTOGRAPHIC
RELEASE: Volunteer does hereby grant and convey unto HICLC all right, title and
interest in any and all photographic images
and video or audio recordings made by HICLC during the Volunteer's Activities with HICLC, including, but not
limited to, any royalties, proceeds, or other benefits derived from such photographs or recordings.
BACKGROUND
CHECK: HICLC performs background screening of staff and key volunteers. This
background check covers state and federal criminal charges and is cleared by
the National Sex Offender Database. By completing this Release and Waiver, you
consent to such an inquiry by HICLC or its designee.
NO
EMPLOYMENT RELATIONSHIP. Volunteer acknowledges that it is not an employee,
subcontractor, or independent contractor of HICLC and that this Release does
not create any employment relationship with HICLC.
OTHER:
Volunteer expressly agrees that this Release is intended to be as broad and
inclusive as permitted by the laws of the State of Alabama and that this
Release shall be governed by and interpreted in accordance with the laws of the
State of Alabama. Volunteer agrees that in the event that any clause or
provision of this Release shall be held to be invalid by any court of competent
jurisdiction, the invalidity of such clause or provision shall not otherwise
affect the remaining provisions of this Release which shall continue to be
enforceable.
IN WITNESS THEREOF,
Volunteer has executed this Release as of the day and year first written.
MINOR (Under 18 years of
Age): In
the event that the participant is a "minor" (under the age of 18),
this form must be signed by a parent or legal guardian.
Volunteer acknowledges that any minor will not be permitted to handle any
equipment prohibited by law or perform any hazardous jobs.