Relay For Life Waiver Packet
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Youth Guidelines For All-Youth Teams
Student Information • Students/Youth need to follow the “Rules of Courtesy” that are utilized by every event participant • Students/Youth that do not raise $100.00 will be required to be picked up by a parent or guardian by 10:00 p.m. • Student/Youth Teams must provide a full team roster, including chaperone information, to the event chair or staff person at least one week prior to the event. Information for each Student/Youth must include how to reach a parent/guardian by telephone at all times during the event. • Hard Copy Waivers (not electronic) are needed for every student/youth that is under the age of 18. • Students must bring ID to the event to receive a wristband. Wristbands will include the cell number of the chaperone. • Student and chaperone will need to attend the mandatory Youth/Chaperone meeting. If student/youth and/or chaperone cannot attend the meeting or receive alternate training, they will need to return home after 10:00 p.m. Chaperone Information • All Youth Teams must have one chaperone for every 10 youth on the team. • Chaperones need to be 25 years of age or older • There must be a chaperone in attendance at the event for the full 24-hours. Chaperones can ensure coverage through “shifts” but need to be sure that one chaperone does not leave the event prior to the next chaperone arriving • Chaperones and students need to attend the mandatory Youth/Chaperone meeting. If student/youth and/or chaperone cannot attend the meeting or receive alternate training, they will need to return home by 10:00 p.m. • Chaperones are responsible for youth conduct at the Relay For Life event We (team captain and chaperone) understand that above, and have included the following documents: Team roster (w/ chaperone information) Waivers for all team members We will attend the mandatory chaperone training on _______________
Team Captain Signature
Chaperone Signature
1
TEAM NUMBER:______________ PRINT NAME: ______________________________
CALIFORNIA DIVISION, INC.
RELEASE AND WAIVER OF LIABILITY The undersigned _________________________ (“Participant”), in exchange for being permitted to participate in the American Cancer Society’s Relay For Life, hereby, on behalf of Participant and Participant’s heirs, executors and administrators, releases, waives discharges and covenants not to sue the American Cancer Society, California Division, Inc. (“ACS”), the owner of the site at which the event is taking place (the “Site Owner”), or any of their respective affiliates, Directors, employees, agents, contractors, volunteers, or other event personnel whether volunteers or paid staff (collectively, the “Releasees”) from any and all liability, claims, demands, damages, causes of action, losses, or expenses (including attorneys’ fees and expenses) to Participant, on account of physical, mental, or emotional injury, or death of the person of Participant or to the property of Participant, whether such injury or death be caused by the negligence, gross negligence of the Releasees or otherwise, suffered either during the event or while traveling to or from the event. Notwithstanding any other provision of this Release and Waiver of Liability, Participant releases ACS and the Site Owner, but no other Releasee, from any liability whatsoever arising from any injury, damage, or death to Participant where said injury, damage, or death is the result of, or arises from any intentional or criminal conduct upon the part of an ACS or Site Owner employee, agent or volunteer. Participant hereby assumes full responsibility for and risk of bodily injury to or death of Participant due to the negligence or gross negligence of Releasees and also releases ACS and the Site Owner, but no other Releasee, from any and all liability for the intentional or criminal acts of its volunteers, agents, and/or employees while Participant participates in or travels to and from the event. Participant further expressly agrees that the foregoing release and waiver is intended to be as broad and inclusive as is permitted by the law of the State of California, and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. Participant has read and voluntarily signs this Release and Waiver of Liability, and further agrees that no oral representations, statement or inducement apart from the foregoing have been made, and that this Release and Waiver of Liability may only be modified by a written document signed by Participant and a duly authorized representative of ACS and of the Site Owner. Signature: ___________________________________
Date:_____________
In case of emergency, contact:___________________
Phone:____________
If Participant is a minor child, then the undersigned hereby states that he/she is the parent or legal guardian of the minor child and, as such, has the authority to and hereby does sign this Release and Waiver of Liability on behalf of the minor child. Signature:___________________________________
Date:_____________
Parent’s/Guardian’s Name:_________________________________ 2
TEAM NUMBER:______________ PRINT NAME: ______________________________
CALIFORNIA DIVISION, INC.
GROUP RELEASE AND WAIVER OF LIABILITY Each of the undersigned (each a “Participant”), in exchange for being permitted to participate in the American Cancer Society’s Relay For Life, hereby, on behalf of Participant and Participant’s heirs, executors and administrators, each releases, waives discharges and covenants not to sue the American Cancer Society, California Division, Inc. (“ACS”), the owner of the site at which the event is taking place (the “Site Owner”), or any of their respective affiliates, Directors, employees, agents, contractors, volunteers, or other event personnel whether volunteers or paid staff (collectively, the “Releasees”) from any and all liability, claims, demands, damages, causes of action, losses, or expenses (including attorneys’ fees and expenses) to a Participant, on account of physical, mental, or emotional injury, or death of the person of a Participant or to the property of a Participant, whether such injury or death be caused by the negligence, gross negligence of the Releasees or otherwise, suffered either during the event or while traveling to or from the event. Notwithstanding any other provision of this Release and Waiver of Liability, each Participant releases ACS and the Site Owner, but no other Releasee, from any liability whatsoever arising from any injury, damage, or death to Participant where said injury, damage, or death is the result of, or arises from any intentional or criminal conduct upon the part of an ACS or Site Owner employee, agent or volunteer. Each Participant hereby assumes full responsibility for and risk of bodily injury to or death of Participant due to the negligence or gross negligence of Releasees and also releases ACS and the Site Owner, but no other Releasee, from any and all liability for the intentional or criminal acts of its volunteers, agents, and/or employees while Participant participates in or travels to and from the event. Each Participant further expressly agrees that the foregoing release and waiver is intended to be as broad and inclusive as is permitted by the law of the State of California, and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. Each Participant has read and voluntarily signs this Release and Waiver of Liability, and further agrees that no oral representations, statement or inducement apart from the foregoing have been made, and that this Release and Waiver of Liability may only be modified with respect to a Participant by a written document signed by such Participant and a duly authorized representative of ACS and of the Site Owner. If a Participant is a minor child, then the undersigned hereby states that he/she is the parent or legal guardian of the minor child and, as such, has the authority to and hereby does sign this Release and Waiver of Liability on behalf of the minor child.
3
NAME OF PARTICIPANT
SIGNATURE OF PARTICIPANT OR GUARADIAN
4
DATE
TEAM NUMBER:______________ PRINT NAME: ______________________________
CALIFORNIA DIVISION, INC.
RELEASE AND WAIVER OF LIABILITY (YOUTH CHAPERONE) The undersigned _________________________ (the “Youth Chaperone”), in exchange for being permitted to participate as a Youth Chaperone for the youth group sponsored by ____________________________ in the American Cancer Society’s Relay For Life, hereby, on behalf of the Youth Chaperone and the Youth Chaperone’s heirs, executors and administrators, releases, waives discharges and covenants not to sue the American Cancer Society, California Division, Inc. (“ACS”), the owner of the site at which the event is taking place (the “Site Owner”), or any of their respective affiliates, Directors, employees, agents, contractors, volunteers, or other event personnel whether volunteers or paid staff (collectively, the “Releasees”) from any and all liability, claims, demands, damages, causes of action, losses, or expenses (including attorneys’ fees and expenses) to the Youth Chaperone, on account of physical, mental, or emotional injury, or death of the person of the Youth Chaperone or to the property of the Youth Chaperone, whether such injury or death be caused by the negligence, gross negligence of the Releasees or otherwise, suffered either during the event or while traveling to or from the event. Notwithstanding any other provision of this Release and Waiver of Liability, the Youth Chaperone releases ACS and the Site Owner, but no other Releasee, from any liability whatsoever arising from any injury, damage, or death to the Youth Chaperone where said injury, damage, or death is the result of, or arises from any intentional or criminal conduct upon the part of an ACS or Site Owner employee, agent or volunteer. The Youth Chaperone hereby assumes full responsibility for and risk of bodily injury to or death of the Youth Chaperone due to the negligence or gross negligence of Releasees and also releases ACS and the Site Owner, but no other Releasee, from any and all liability for the intentional or criminal acts of its volunteers, agents, and/or employees while the Youth Chaperone participates in or travels to and from the event. The Youth Chaperone further expressly agrees that the foregoing release and waiver is intended to be as broad and inclusive as is permitted by the law of the State of California, and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. The Youth Chaperone has read and voluntarily signs this Release and Waiver of Liability, and further agrees that no oral representations, statement or inducement apart from the foregoing have been made, and that this Release and Waiver of Liability may only be modified by a written document signed by the Youth Chaperone and a duly authorized representative of ACS and of the Site Owner. Signature: ___________________________________
Date:_____________
In case of emergency, contact:___________________
Phone:____________
5
TEAM NUMBER:______________ PRINT NAME: __________________ CALIFORNIA DIVISION, INC.
RELEASE AND WAIVER OF LIABILITY (YOUTH CHAPERONE SPONSOR) The undersigned _________________________ (the “Youth Chaperone Sponsor”), in exchange for the youth group known as _______________________________ (the “Youth Group”) being permitted to participate in the American Cancer Society’s Relay For Life, where they will be chaperoned by _________________________ (the “Youth Chaperone”), hereby, on behalf of the Youth Chaperone Sponsor and its officers, directors, employees, agents, volunteers, successors and assigns, releases, waives discharges and covenants not to sue the American Cancer Society, California Division, Inc. (“ACS”), the owner of the site at which the event is taking place (the “Site Owner”), or any of their respective affiliates, Directors, employees, agents, contractors, volunteers, or other event personnel whether volunteers or paid staff (collectively, the “Releasees”) from any and all liability, claims, demands, damages, causes of action, losses, or expenses (including attorneys’ fees and expenses) to the Youth Chaperone Sponsor or the Youth Chaperone, on account of physical, mental, or emotional injury, or death of the person of the Youth Chaperone or to the property of the Youth Chaperone, whether such injury or death be caused by the negligence, gross negligence of the Releasees or otherwise, suffered either during the event or while traveling to or from the event. The Youth Chaperone Sponsor represents and warrants to ACS that the Youth Chaperone is an approved youth chaperone for the Youth Group currently in good standing, and the Youth Chaperone Sponsor consents to the Youth Chaperone acting as a chaperone for the Youth Group for this event. Notwithstanding any other provision of this Release and Waiver of Liability, the Youth Chaperone Sponsor releases ACS and the Site Owner, but no other Releasee, from any liability whatsoever arising from any injury, damage, or death to the Youth Chaperone where said injury, damage, or death is the result of, or arises from any intentional or criminal conduct upon the part of an ACS or Site Owner employee, agent or volunteer. The Youth Chaperone Sponsor hereby assumes full responsibility for and risk of bodily injury to or death of the Youth Chaperone due to the negligence or gross negligence of Releasees and also releases ACS and the Site Owner, but no other Releasee, from any and all liability for the intentional or criminal acts of its volunteers, agents, and/or employees while the Youth Chaperone participates in or travels to and from the event. The Youth Chaperone Sponsor further expressly agrees that the foregoing release and waiver is intended to be as broad and inclusive as is permitted by the law of the State of California, and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. The Youth Chaperone Sponsor has read and voluntarily signs this Release and Waiver of Liability, and further agrees that no oral representations, statement or inducement apart from the foregoing have been made, and that this Release and Waiver of Liability may only be modified by a written document signed by the Youth Chaperone Sponsor and a duly authorized representative of ACS and of the Site Owner. Signature:___________________________ Name:______________________________ Title:_______________________________
Date:______________
6
Student Information • Students/Youth need to follow the “Rules of Courtesy” that are utilized by every event participant • Students/Youth that do not raise $100.00 will be required to be picked up by a parent or guardian by 10:00 p.m. • Student/Youth Teams must provide a full team roster, including chaperone information, to the event chair or staff person at least one week prior to the event. Information for each Student/Youth must include how to reach a parent/guardian by telephone at all times during the event. • Hard Copy Waivers (not electronic) are needed for every student/youth that is under the age of 18. • Students must bring ID to the event to receive a wristband. Wristbands will include the cell number of the chaperone. • Student and chaperone will need to attend the mandatory Youth/Chaperone meeting. If student/youth and/or chaperone cannot attend the meeting or receive alternate training, they will need to return home after 10:00 p.m. Chaperone Information • All Youth Teams must have one chaperone for every 10 youth on the team. • Chaperones need to be 25 years of age or older • There must be a chaperone in attendance at the event for the full 24-hours. Chaperones can ensure coverage through “shifts” but need to be sure that one chaperone does not leave the event prior to the next chaperone arriving • Chaperones and students need to attend the mandatory Youth/Chaperone meeting. If student/youth and/or chaperone cannot attend the meeting or receive alternate training, they will need to return home by 10:00 p.m. • Chaperones are responsible for youth conduct at the Relay For Life event We (team captain and chaperone) understand that above, and have included the following documents: Team roster (w/ chaperone information) Waivers for all team members We will attend the mandatory chaperone training on _______________
Team Captain Signature
Chaperone Signature
1
TEAM NUMBER:______________ PRINT NAME: ______________________________
CALIFORNIA DIVISION, INC.
RELEASE AND WAIVER OF LIABILITY The undersigned _________________________ (“Participant”), in exchange for being permitted to participate in the American Cancer Society’s Relay For Life, hereby, on behalf of Participant and Participant’s heirs, executors and administrators, releases, waives discharges and covenants not to sue the American Cancer Society, California Division, Inc. (“ACS”), the owner of the site at which the event is taking place (the “Site Owner”), or any of their respective affiliates, Directors, employees, agents, contractors, volunteers, or other event personnel whether volunteers or paid staff (collectively, the “Releasees”) from any and all liability, claims, demands, damages, causes of action, losses, or expenses (including attorneys’ fees and expenses) to Participant, on account of physical, mental, or emotional injury, or death of the person of Participant or to the property of Participant, whether such injury or death be caused by the negligence, gross negligence of the Releasees or otherwise, suffered either during the event or while traveling to or from the event. Notwithstanding any other provision of this Release and Waiver of Liability, Participant releases ACS and the Site Owner, but no other Releasee, from any liability whatsoever arising from any injury, damage, or death to Participant where said injury, damage, or death is the result of, or arises from any intentional or criminal conduct upon the part of an ACS or Site Owner employee, agent or volunteer. Participant hereby assumes full responsibility for and risk of bodily injury to or death of Participant due to the negligence or gross negligence of Releasees and also releases ACS and the Site Owner, but no other Releasee, from any and all liability for the intentional or criminal acts of its volunteers, agents, and/or employees while Participant participates in or travels to and from the event. Participant further expressly agrees that the foregoing release and waiver is intended to be as broad and inclusive as is permitted by the law of the State of California, and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. Participant has read and voluntarily signs this Release and Waiver of Liability, and further agrees that no oral representations, statement or inducement apart from the foregoing have been made, and that this Release and Waiver of Liability may only be modified by a written document signed by Participant and a duly authorized representative of ACS and of the Site Owner. Signature: ___________________________________
Date:_____________
In case of emergency, contact:___________________
Phone:____________
If Participant is a minor child, then the undersigned hereby states that he/she is the parent or legal guardian of the minor child and, as such, has the authority to and hereby does sign this Release and Waiver of Liability on behalf of the minor child. Signature:___________________________________
Date:_____________
Parent’s/Guardian’s Name:_________________________________ 2
TEAM NUMBER:______________ PRINT NAME: ______________________________
CALIFORNIA DIVISION, INC.
GROUP RELEASE AND WAIVER OF LIABILITY Each of the undersigned (each a “Participant”), in exchange for being permitted to participate in the American Cancer Society’s Relay For Life, hereby, on behalf of Participant and Participant’s heirs, executors and administrators, each releases, waives discharges and covenants not to sue the American Cancer Society, California Division, Inc. (“ACS”), the owner of the site at which the event is taking place (the “Site Owner”), or any of their respective affiliates, Directors, employees, agents, contractors, volunteers, or other event personnel whether volunteers or paid staff (collectively, the “Releasees”) from any and all liability, claims, demands, damages, causes of action, losses, or expenses (including attorneys’ fees and expenses) to a Participant, on account of physical, mental, or emotional injury, or death of the person of a Participant or to the property of a Participant, whether such injury or death be caused by the negligence, gross negligence of the Releasees or otherwise, suffered either during the event or while traveling to or from the event. Notwithstanding any other provision of this Release and Waiver of Liability, each Participant releases ACS and the Site Owner, but no other Releasee, from any liability whatsoever arising from any injury, damage, or death to Participant where said injury, damage, or death is the result of, or arises from any intentional or criminal conduct upon the part of an ACS or Site Owner employee, agent or volunteer. Each Participant hereby assumes full responsibility for and risk of bodily injury to or death of Participant due to the negligence or gross negligence of Releasees and also releases ACS and the Site Owner, but no other Releasee, from any and all liability for the intentional or criminal acts of its volunteers, agents, and/or employees while Participant participates in or travels to and from the event. Each Participant further expressly agrees that the foregoing release and waiver is intended to be as broad and inclusive as is permitted by the law of the State of California, and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. Each Participant has read and voluntarily signs this Release and Waiver of Liability, and further agrees that no oral representations, statement or inducement apart from the foregoing have been made, and that this Release and Waiver of Liability may only be modified with respect to a Participant by a written document signed by such Participant and a duly authorized representative of ACS and of the Site Owner. If a Participant is a minor child, then the undersigned hereby states that he/she is the parent or legal guardian of the minor child and, as such, has the authority to and hereby does sign this Release and Waiver of Liability on behalf of the minor child.
3
NAME OF PARTICIPANT
SIGNATURE OF PARTICIPANT OR GUARADIAN
4
DATE
TEAM NUMBER:______________ PRINT NAME: ______________________________
CALIFORNIA DIVISION, INC.
RELEASE AND WAIVER OF LIABILITY (YOUTH CHAPERONE) The undersigned _________________________ (the “Youth Chaperone”), in exchange for being permitted to participate as a Youth Chaperone for the youth group sponsored by ____________________________ in the American Cancer Society’s Relay For Life, hereby, on behalf of the Youth Chaperone and the Youth Chaperone’s heirs, executors and administrators, releases, waives discharges and covenants not to sue the American Cancer Society, California Division, Inc. (“ACS”), the owner of the site at which the event is taking place (the “Site Owner”), or any of their respective affiliates, Directors, employees, agents, contractors, volunteers, or other event personnel whether volunteers or paid staff (collectively, the “Releasees”) from any and all liability, claims, demands, damages, causes of action, losses, or expenses (including attorneys’ fees and expenses) to the Youth Chaperone, on account of physical, mental, or emotional injury, or death of the person of the Youth Chaperone or to the property of the Youth Chaperone, whether such injury or death be caused by the negligence, gross negligence of the Releasees or otherwise, suffered either during the event or while traveling to or from the event. Notwithstanding any other provision of this Release and Waiver of Liability, the Youth Chaperone releases ACS and the Site Owner, but no other Releasee, from any liability whatsoever arising from any injury, damage, or death to the Youth Chaperone where said injury, damage, or death is the result of, or arises from any intentional or criminal conduct upon the part of an ACS or Site Owner employee, agent or volunteer. The Youth Chaperone hereby assumes full responsibility for and risk of bodily injury to or death of the Youth Chaperone due to the negligence or gross negligence of Releasees and also releases ACS and the Site Owner, but no other Releasee, from any and all liability for the intentional or criminal acts of its volunteers, agents, and/or employees while the Youth Chaperone participates in or travels to and from the event. The Youth Chaperone further expressly agrees that the foregoing release and waiver is intended to be as broad and inclusive as is permitted by the law of the State of California, and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. The Youth Chaperone has read and voluntarily signs this Release and Waiver of Liability, and further agrees that no oral representations, statement or inducement apart from the foregoing have been made, and that this Release and Waiver of Liability may only be modified by a written document signed by the Youth Chaperone and a duly authorized representative of ACS and of the Site Owner. Signature: ___________________________________
Date:_____________
In case of emergency, contact:___________________
Phone:____________
5
TEAM NUMBER:______________ PRINT NAME: __________________ CALIFORNIA DIVISION, INC.
RELEASE AND WAIVER OF LIABILITY (YOUTH CHAPERONE SPONSOR) The undersigned _________________________ (the “Youth Chaperone Sponsor”), in exchange for the youth group known as _______________________________ (the “Youth Group”) being permitted to participate in the American Cancer Society’s Relay For Life, where they will be chaperoned by _________________________ (the “Youth Chaperone”), hereby, on behalf of the Youth Chaperone Sponsor and its officers, directors, employees, agents, volunteers, successors and assigns, releases, waives discharges and covenants not to sue the American Cancer Society, California Division, Inc. (“ACS”), the owner of the site at which the event is taking place (the “Site Owner”), or any of their respective affiliates, Directors, employees, agents, contractors, volunteers, or other event personnel whether volunteers or paid staff (collectively, the “Releasees”) from any and all liability, claims, demands, damages, causes of action, losses, or expenses (including attorneys’ fees and expenses) to the Youth Chaperone Sponsor or the Youth Chaperone, on account of physical, mental, or emotional injury, or death of the person of the Youth Chaperone or to the property of the Youth Chaperone, whether such injury or death be caused by the negligence, gross negligence of the Releasees or otherwise, suffered either during the event or while traveling to or from the event. The Youth Chaperone Sponsor represents and warrants to ACS that the Youth Chaperone is an approved youth chaperone for the Youth Group currently in good standing, and the Youth Chaperone Sponsor consents to the Youth Chaperone acting as a chaperone for the Youth Group for this event. Notwithstanding any other provision of this Release and Waiver of Liability, the Youth Chaperone Sponsor releases ACS and the Site Owner, but no other Releasee, from any liability whatsoever arising from any injury, damage, or death to the Youth Chaperone where said injury, damage, or death is the result of, or arises from any intentional or criminal conduct upon the part of an ACS or Site Owner employee, agent or volunteer. The Youth Chaperone Sponsor hereby assumes full responsibility for and risk of bodily injury to or death of the Youth Chaperone due to the negligence or gross negligence of Releasees and also releases ACS and the Site Owner, but no other Releasee, from any and all liability for the intentional or criminal acts of its volunteers, agents, and/or employees while the Youth Chaperone participates in or travels to and from the event. The Youth Chaperone Sponsor further expressly agrees that the foregoing release and waiver is intended to be as broad and inclusive as is permitted by the law of the State of California, and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. The Youth Chaperone Sponsor has read and voluntarily signs this Release and Waiver of Liability, and further agrees that no oral representations, statement or inducement apart from the foregoing have been made, and that this Release and Waiver of Liability may only be modified by a written document signed by the Youth Chaperone Sponsor and a duly authorized representative of ACS and of the Site Owner. Signature:___________________________ Name:______________________________ Title:_______________________________
Date:______________
6
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