VSL Summer: Required form

REQUIRED FORMS

If you are participating in a virtual summer service-learning program with Amizade, please fill out this form.

  • AGREEMENT, WAIVER AND RELEASE

    On July, 30, 2020, participants in the Amizade Pittsburgh Summer Virtual Service Learning program will participate in a hands-on cooking class. Students will cook independently in their own homes while being led virtually by community partners in Jamaica. This release is intended to discharge in advance Amizade, its officers, employees and agents from any and all liability arising out of or connected in any way with my participation in this cooking class, even though that liability may arise out of negligence or carelessness on the part of those parties. I understand that my participation in the cooking class involves an element of risk and danger of accidents; knowing those risks, I hereby assume those risks. I will listen closely to facilitator instructions and actively participate in a safe manner. I hereby waive, release and discharge any and all claims for damage for personal injury, death or property damage which I may have, or which may hereafter accrue to me, as a result of participation in Amizade’s cooking class. I agree to indemnify and to hold harmless, Amizade, its officers, employees and agents from any loss, liability, damage, cost or expense which they may incur as the result of my death or any injury or property damage that I may sustain while participating in this activity I agree that the foregoing obligation shall be binding upon me personally, as well as upon my heirs, executors and administrators, assigns, successors, representatives, and all members of my family, including my spouse and/or any minors accompanying me. Moreover, I agree to release and discharge any and all Releasees from claims, whether current or future, that may arise from my participation in this travel program and related activities. I HAVE CAREFULLY READ THIS AGREEMENT, WAIVER AND RELEASE AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN MYSELF AND AMIZADE AND I SIGN IT OF MY OWN FREE WILL.
  • Date Format: MM slash DD slash YYYY
  • CONSENT OF PARENT/GUARDIAN

    I am the parent or legal guardian of the participant listed above. I have reviewed the Cooking Class Waiver Form and understand the nature of the activity as well as the risks and danger of accidents. I hereby affirmatively state that my student is physically able to participate in said activity. I hereby consent that my student may participate in the virtual cooking class on July 30, 2020, and I hereby execute the Agreement, Waiver and Release on his/her behalf. I agree to indemnify and hold harmless in Amizade, its officers, employees and agents from any loss, liability, damage, cost or expense which they may incur as the result of my student’s death or any injury or property damage that my student may sustain while participating in this activity. I agree that the foregoing obligation shall be binding upon me personally, as well as upon my heirs, executors and administrators, assigns, successors, representatives, and all members of my family, including my spouse and/or any minors accompanying me. Moreover, I agree to release and discharge any and all Releasees from claims, whether current or future, that may arise from my participation in this travel program and related activities. I HAVE CAREFULLY READ THIS AGREEMENT, WAIVER AND RELEASE AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN MYSELF AND AMIZADE AND I SIGN IT OF MY OWN FREE WILL.
  • Date Format: MM slash DD slash YYYY