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FORM 22
Employee Waiver and Release
WAIVER AND RELEASE OF LIABILITY
1. I acknowledge and fully understand that I may be engaging in an activity or work that involves risk of serious injury, permanent disability, or death, and severe social and economic losses which might result not only from my own actions, inactions or negligence by actions, inaction of others, or the conditions of the premises or of any equipment used. Further, that there may be other risks not known to us or not reasonably foreseeable at this time.
2. I assume all the forgoing risks and accept personal responsibility of the damages following any such injury, permanent disability, or death.
3. Intending to be legally bound, I do hereby release, waive, discharge and covenance not to sue your business name here, its affiliates, their respective administrators, officers, directors, agents, and other employees the organization, other participants, owners and leasers of premises where work is performed, all of which are hereinafter referred to as "releasees", from any and all liability to each of the undersigned, his or her heirs and next of kin for any claims, demands, losses, or damages on account of injury, including death or damage to property, caused or alleged to be caused in whole or in part by the negligence of the releasee or otherwise in connection with any work performed.
4. In the event that I sustain injury or illness while working for your business name here. I hereby authorize any emergency first aid, medication, medical treatment, or surgery deemed necessary by licensed medical personnel. I also give my permission for attending medical personnel, to execute on my behalf my permission forms or other necessary medical documents and act in my behalf if I am not immediately able to do so.
5. I hereby consent to allow my picture to appear in any official documentary, promotional, exclusive television, radio or film coverage to promote your business name here and without compensation to me.
THE UNDERSIGNED HAS READ THE ABOVE WAIVER AND RELEASE AND UNDERSTANDS THAT HE/SHE HAS GIVEN UP SUBSTANTIAL RIGHTS BY VOLUNTARILY SIGNING THIS WAIVER.
First Name:_____________________ MI:____ Last Name:_____________________ Age:________
SIGNATURE______________________________________ DATE__________
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