Liability Release Form

Touchstone Youth Resource Services

LIABILITY RELEASE FORM

CiViL Groups/CiViL Service

Disaster Response

2010 Middle Tennessee Flood

Volunteer Name (Please Print):________________________________________

  I hereby state that I do have personal health insurance and will in no way hold CiViL Groups, Touchstone Youth Resource Services, Inc., or any of its officers, employees, or volunteers liable for any injuries sustained while responding as a volunteer to the Middle Tennessee flood relief efforts.

 _______________________________­­_____________           ________________

Signature of Volunteer                                                                         Date

If Volunteer is a minor:

 ____________________________________________            ________________

Signature of Parent or Guardian                                                           Date

 ____________________________________________          _________________ 

Name of Parent or Guardian (please print)                                         Phone