Waiver and Release WAIVER AND RELEASE WARNING OF RISK Despite careful and proper preparation, instruction, medical advice, conditioning and equipment, there is still a risk of serious injury when participation in any actvity or program. Understandably, not all hazards and dangers can be foreseen. Providers of services and recipients of services must understand that certain risks, dangers and injuries exist and may occur due to, inclement weather, slipping, falling, equipment failure, failure in supervision, premises defects and all other circumstances inherent to activities or programs. In this regard, it must be recognized that it is possible for the City of Des Plaines, Healthy Community Partnership, or Lutheran General Hospital, to guarantee absolute safety of lack of injury. Please read this form carefully and be aware that in providing, receiving or accepting service for this program or activity, you will be expressly assuming the risk and legal liability and waiving and releasing all claims for injuries, damages or loss which you may sustain as result of participating in any all activities connected with and associated with your services, program or participation (including transportation services, when provided).WAIVER AND RELEASE OF ALL CLAIMS AND ASSUMPTION OF RISK As a volunteer, I recognize and acknowledge that there are certain risks of physical injury to volunteers in this program/activity, and I voluntarily agree to assume the full risk of any and all injuries, damages or loss, regardless of severity, that I may sustain as a result of said provision of services, acceptance or receipt of services. I further agree to waive and relinquish all claims I may have or which may accrue to me against the City of Des Plaines, the Healthy Community Partnership, and Lutheran General Hospital, including their respective officers, officials, agents, volunteers and employees (hereinafter collectively referred to as โPartiesโ), as a result of providing or receiving services in this program or activity. I do hereby fully release and forever discharge the Parties from any and all claims for injuries, damages, or loss that I may have or which may accrue to me and arising out of, connected with, or in any way associated with my 1) provision of services, or b) acceptance or receiving of services. By submitting this form, I confirm that I have read and fully understand the above important information, warning of risk, assumption of risk and waiver and release of all claims.Name(Required) Phone(Required)Email Address(Required) Date(Required) MM slash DD slash YYYY
