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Nevada
Civil War Volunteers
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Please PRINT this form and clearly enter the requested information
| Adult #1 | Name: | DOB: |
| Adult #2 | Name: | DOB: |
| Minor #1 | Name: | DOB: |
| Minor #2 | Name: | DOB: |
| Minor #3 | Name: | DOB: |
| Address: | City: | State/ZIP: |
| Phone: | E-mail: | Receive The Sentinel via Mail Webpage |
I, the undersigned, agree to abide by the Bylaws and Safety Standards governing the Nevada
Civil War Volunteers Incorporated, and release them of any and all
obligations.
Know all men by these presents, that I do hereby, for all heirs, executors,
administrators and assigns, fully and forever, with the full knowledge that there is a
possibility of injuries to my or my child's anatomy, release and discharge the NEVADA CIVIL WAR VOLUNTEERS, INC. (all or part), of and from all
claims, demands, damages, rights of action and causes of action, on account of either
known or unknown, concealed or hidden, external or internal, personal, physical, mental or
nervous injuries or disease, or damage to any portion of my or my child's anatomy, or damage to personal
property of whatsoever description resulting, or which could or may result from an
accident or anything which occurred.
I do further release said NEVADA CIVIL WAR VOLUNTEERS, INC. (all or part), from all suits,
debts, dues, covenants, controversies, agreements, promises, variances, trespasses,
judgments, executions, claims, and demands whatsoever in law or in equity.
I also understand and agree that this full and final
release is intended to cover and does cover all and any future injuries not known to
either party hereto, or which may later develop, or be discovered, including the effects
or consequences thereof and including all causes of action thereby.
I further understand that this is a compromise settlement
without any admission of liability on the part of the NEVADA CIVIL WAR VOLUNTEERS, INC. (all or part), and, in executing
this release, that participation in the NEVADA CIVIL
WAR VOLUNTEERS, INC. activities includes, but is not limited to the re-enactment of
battle scenes between opposing forces under situations closely approximating actual
battles utilizing black powder, small arms, cannon and swords. Consent is hereby
given to whatever medical care might be available and or provided for injury occurring
during the above activities when authorized or contracted for by any officer of the NEVADA CIVIL WAR VOLUNTEERS, INC.
I hereby state that I am a declarant in the foregoing declaration; or, that I am
the parent or legal guardian of a minor child whose name appears above and am
empowered to execute this release. I also state that I have read the same, understand the contents thereof, and agree to the
contents thereof.
| Adult #1 | Signature: | Date: |
| Adult #2 | Signature: | Date: |
| Please send Personal Check or Money Order with this application to: Nevada Civil War Volunteers, Incorporated P.O. Box 11033 Reno, NV 89510 |
STAFF USE ONLY: Dues Paid: $_________________ Date Received: ______________ Received by: ____________________________________________ |