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NORTH DAKOTA 4-H SHOOTING SPORTS PARENTS OR <br />GUARDIANS AGREEMENT OF WAIVER OF LIABILITY <br />INDEMNIFICATION AND MEDICAL RELEASE <br /> <br />The undersigned parent and natural guardian or legal guardian does hereby acknowledge that <br />he/she is aware of the dangers involved in participating in North Dakota 4-H shooting sports. <br /> <br />Said undersigned parent and natural guardian or legal guardian does hereby.represent that <br />he/she is, in fact, acting in such capacity and agrees on behalf of the participant and his/her <br />executors, administrators, heirs, next of kin, successors, and assigns, to: <br />a. waive, release and discharge the State of North Dakota, and its officers, agents, employees <br />and 4-H volunteers from any and all liability for participant's death, disability, personal injury~ <br />property damage, property theft or actions of any kind which may hereafter accrue to <br />participant and his/her estate; and <br /> <br />b. indemnify and hold harmless the State of North Dakota, and its officers, agents, employees <br />and 4-H volunteers from and against any and all liabilities, damages, expenses and claims <br />made by other individuals or entities as a result of participant's participation or actions during <br />this activity or event. <br /> <br />The undersigned further consents to and authorizes medical treatment to the participant, <br />which may be deemed advisable in the event of injury, accident or illness during this activity <br />or event. The undersigned also certifies that participant is covered by the following health <br />insurance policy. <br /> <br />This release and waiver shall be construed broadly' to provide a release and waiver to the <br />maximum extent permissible under applicable law. <br /> <br />I, the undersigned, acknowledge that I have read and understand the above release. <br /> <br />Name of Minor Age <br /> <br />Name of Parent or Guardian <br /> <br />Medical Insurance Company <br /> <br />Policy # <br /> <br />Signature Date <br /> <br />(Must be completed, signed and returned to the local County Extension Office before <br />youth will be allowed to participate in 4-H Shooting Sports Program/Event) <br /> <br />J:XAH Youth~Project Arcas~Outdoor Sicills~SMcdical l~tcasc.wpd <br /> <br /> <br />