Waiver and Hold Harmless Agreement
iJourney: Success4life
#FtBenningTeenSummit2015
Note: By executing this document you waive certain legal rights on behalf of
yourself, your family, your dependent child and your invited guests attending AND
OR participating in the 28 February-iJourney Teen Summit, Concert and/or Lock-in.
Name of Child/Children:_________________________________________________________
I, _________________________________________________desire that the above named
child/children participate and attend the Fort Benning Teen Summit, Concert and Lock-In.
In consideration of the benefit of participating in this event, I hereby agree to release and hold
harmless the United Sates and Fort Benning, GA from any damages to property or injuries which I
or my dependent child/ward and any of my invited guests could suffer in/at this event.
I acknowledge that attendance and or participation in this event entails known and unanticipated
risks which could result in physical or emotional injury, paralysis, death or damage to my child or
children (if I am executing this agreement with respect to such child or children), to property, or to
third parties. I agree that all activities and use of all facilities relating to participation in Child,
Youth & School Services(CYSS) sponsored activities shall be undertaken at the sole risk of the
youth/family and that the United States Government, Department of Defense, its officers,
representatives, agents, employees, leaders, and youth of any CYSS program shall not be liable for
any claims, demands, injuries, damages, actions or causes of action, programs/events whatsoever,
to me, my family, or my property arising out of or connected with participation in the programs
/events or the premises where the programs/events occur and I do hereby expressly forever
release, discharge and hold harmless the United States, Fort Benning, Georgia, its officers,
representatives, agents, employees, leaders and youth of the CYSS programs from all such claims,
demands, injuries, damage to person or property, actions or causes of action, including but not
limited to all acts of active or passive negligence on the part of the United States, Ft. Benning,
Georgia, CYSS programs, their representatives, agents or employees.
BY SIGNING, I DECLARE THAT I HAVE READ AND VOLUNTARILY ENTER INTO THE TERMS OF THIS
WAIVER AND HOLD HARMLESS AGREEMENT.
_______________________________________________
_________________
PARENT/GUARDIAN SIGNATURE
DATE
***Must have signed waiver/hold harmless agreement to participate