Site Visit Waiver.pdf

HOLD HARMLESS AGREEMENT AND RELEASE FROM LIABILITY

I, , on my own behalf, in consideration (Poolee/Applicants printed full name) and for the purpose of release liability to the United States Marine Corps, and all personnel, agents, or employees, therein, acting officially or otherwise; from any and all injuries incurred enroute, during, or returning from this activity. I acknowledge that this agreement is limited solely for the purpose of the aforementioned activity and binds the United States in no manner whatsoever. Furthermore, I attest that this agreement is entered into voluntarily and that I understand that participation in the aforementioned activity is also voluntary. I acknowledge that I have been provided the opportunity to ask questions as to any of the risks foreseeable in connection with the aforementioned activity and transportation connected to/from this activity, which will be on

(Date of Event)

This agreement has been explained as to the above terms, provisions, and statements and I hereby accept all the said terms, provisions, and statements listed above as my own unconditionally and voluntarily.

(Signature of Poolee/Applicant) (Date)

PARENTS OR GUARDIANS AGREEMENT

To be used when poolee/applicant is a minor under 18 years of age. I/We hereby execute and subscribe to the above waiver as the parents or guardian of the named minor and consent to his/her being on the property, or using the indicated facilities on the stated military activity. I/We jointly and severally, for ourselves, our heirs, executors and administrators, agree to hold harmless the United States Marine Corps, its officers, personnel, agents and employees, acting officially or otherwise, against all suits, actions, claims, costs or demands, whether arising from sole or concurrent negligence or otherwise (including those resulting from death, personal injury and property damage) to which the United States, its officers, personnel, agents and employees may be subject by reason of being on the property or using the indicated facilities of the stated military activity for the activity described above.

(Printed Name of Minor) Signature of (Parent or Guardian) (Date)

EMERGENCY DATA INFORMATION

Notify Address Telephone

(Name of Event)

NAVMC 11680 (11-09) (EF)

Adobe Designer 8.0

HOLD HARMLESS AGREEMENT AND RELEASE FROM LIABILITY

I, , on my own behalf, in consideration (Poolee/Applicants printed full name) and for the purpose of release liability to the United States Marine Corps, and all personnel, agents, or employees, therein, acting officially or otherwise; from any and all injuries incurred enroute, during, or returning from this activity. I acknowledge that this agreement is limited solely for the purpose of the aforementioned activity and binds the United States in no manner whatsoever. Furthermore, I attest that this agreement is entered into voluntarily and that I understand that participation in the aforementioned activity is also voluntary. I acknowledge that I have been provided the opportunity to ask questions as to any of the risks foreseeable in connection with the aforementioned activity and transportation connected to/from this activity, which will be on (Date of Event) This agreement has been explained as to the above terms, provisions, and statements and I hereby accept all the said terms, provisions, and statements listed above as my own unconditionally and voluntarily.

(Signature of Poolee/Applicant) (Date)

PARENTS OR GUARDIANS AGREEMENT

To be used when poolee/applicant is a minor under 18 years of age. I/We hereby execute and subscribe to the above waiver as the parents or guardian of the named minor and consent to his/her being on the property, or using the indicated facilities on the stated military activity. I/We jointly and severally, for ourselves, our heirs, executors and administrators, agree to hold harmless the United States Marine Corps, its officers, personnel, agents and employees, acting officially or otherwise, against all suits, actions, claims, costs or demands, whether arising from sole or concurrent negligence or otherwise (including those resulting from death, personal injury and property damage) to which the United States, its officers, personnel, agents and employees may be subject by reason of being on the property or using the indicated facilities of the stated military activity for the activity described above.

(Printed Name of Minor) Signature of (Parent or Guardian) (Date)

EMERGENCY DATA INFORMATION

(Name of Event)

NAVMC 11680 (11-09) (EF)

Adobe Designer 8.0

COMMANDANT OF THE MARINE CORPS HEADQUARTERS UNITED STATES MARINE CORPS

amelia.coram Normal Laurie Ann Somers Microsoft Office Word

11/17/2009 4:05:00 PM

12/1/2009 3:06:00 PM

12/1/2009 3:06:00 PM

NMCI

39424

12/1/2009 3:06:00 PM