Collegiate Association for Social Entrepreneurship Texas A&M Campus Community Garden Activity Form and Waiver of Liability
Last Name_________________________________ First Name___________________________________
Address________________________________________City_____________________Zip____________
Phone ______________________________Emergency Phone____________________________________
Will anyone else be working on the garden plot? (Circle one) YES NO (If yes, please fill out an additional Activity Form and Wavier of Liability Form with the additional person’s information)
PLEASE READ AND SIGN BELOW For and in consideration of permitting THOSE LISTED ON THE Activity FORM to participate in the COMMUNITY GARDEN PROGRAM, organized and sponsored by the Collegiate Association for Social Entrepreneurship, the undersigned hereby voluntarily forever releases, discharges, waives and relinquishes any and all actions or causes of action for personal injury, property damage or wrongful death, occurring to the Undersigned out of the participation of said program or any activities thereto; wherever, or however the same may occur and whatever period said activities may continue, and the Undersigned does for himself/herself, his/hers heirs, executors, administrators, and assigns hereby release, waive, discharge and relinquish any action or causes of action, aforesaid, which may hereafter arise for himself/herself, and for his/hers heirs, executors, administrators or assigns shall not prosecute or present any claim for personal injury, property damage or wrongful death against the Collegiate Association for Social Entrepreneurship or any of its officers, agents, servants, or employees (hereinafter referred to as "Releases") for any of said causes of action including, but not limited to, losses caused by the passive or active negligence of the Releases. The Undersigned acknowledges, understands and assumes the risks, if any, arising from the conditions of the various recreational facilities, community garden plots, surrounding field and adjacent school or holistic garden grounds and parking lots; and acknowledges and understands that this Organizations waiver includes, but is not limited to, any action or cause of action arising from (1) the performance, or failure to perform, maintenance, inspection, supervision, control or security of said areas, (2) the failure to warn of dangerous conditions as existing on or near said locations, or (3) any hidden, latent or obvious defects or dangerous conditions existing on or near said locations.
IT IS THE INTENTION OF THOSE LISTED ON THIS ACTIVITY FORM BY THIS INSTRUMENT TO EXEMPT AND RELIEVE RELEASEES FROM LIABILITY FOR PERSONAL INJURY, PROPERTY DAMAGE AND WRONGFUL DEATH CAUSED BY THE PASSIVE OR ACTIVE NEGLIGENCE OF THE RELEASEES.
I have read and hereby agree to abide by the Texas A&M Campus Community Garden Rules and Procedures. I further acknowledge that my participation in the Texas A&M Campus Community Garden Program will be in jeopardy should I fail to adhere to the rules. I give permission to the Collegiate Association for Social Entrepreneurship to photograph me or my children participating in the programs for use in future Organization publications and understand that I will not receive any compensation for such use. Furthermore, we give our permission to have the above-named participant treated in the event of accident or illness.
SIGNATURE_________________________________________________ DATE______________
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Liability Form |