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700 Tabor St.,,
Waveland, Ms. 39576
Phone: (228) 466-4630
Cell: (228) 209-8822
PARTICIPANT LIABILITY RELEASE FORM
(Please read before signing, as this constitutes the agreement with you as a volunteer understanding your working relationship with and Katrina Relief, Waveland Citizens Fund and the City of Waveland's )
I,________________________________________________, acknowledge and state the following; I have chosen to travel to the work site to perform cleanup/construction work in disaster response.
I understand that this work entails a risk of physical injury and often involves hard physical labor, heavy lifting, and other strenuous activity; and that some activities may take place on ladders and building framing other than ground level. I certify that I am in good health and physically able to perform this type of work.
I understand that I am engaging in this project at my own risk. I understand that this is a “grass roots” activity to support individuals adversely affected by the disaster. I assume all risk and responsibility for any damage or injury to my property or any personal injury, which I may sustain while involved in this project.
In the event that Katrina Relief thru the City of Waveland long term recovery office arranges accommodations, I understand that they are not responsible nor liable for my personal effects and property and that they will not provide lock up or security for any items. I will hold them harmless in the event of theft resulting from any source or cause. I further understand that I am to abide by whatever rules and regulations may be in effect for the accommodations at the time.
By my signature, for myself, my estate and my heirs, I release, discharge, indemnify and forever hold Your Agency together with their officers, agents, servants, and employees, harmless from any and all causes of action arising from my participation in this project, and travel or lodging associated therewith, including any damages which may be caused by their own negligence.
Date of last Tetanus:_______________
Signature:_______________________________________ Date:__________________
Address:________________________________________________________________
Person to contact in case of emergency:_______________________________________
Telephone or means of contacting them:_______________________________________
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