New Horizons
Waiver Form for All Participants
Date: __________________________________________________________
Event or Activity: __________________________________________________________
Location: __________________________________________________________
In consideration of being permitted to participate in the event or activity described above, which is
held and/or sponsored by New Horizons of DuPage (“New Horizons”), I, on behalf of myself, my heirs,
personal representatives or assigns, do hereby release, waive, discharge, hold harmless and
covenant not to sue New Horizons, its officers, directors, committee members, invited guests,
speakers, and agents, from liability from any and all claims including the negligence of New Horizons,
its officers, directors, committee members and agents, resulting in personal injury, accidents or illnesses
(including death), and property loss arising from, but not limited to, participation in any New Horizons’
events or activities.
I acknowledge that I am signing the agreement freely and voluntarily, and intend by my signature to
be a complete and unconditional release of all liability to the greatest extent allowed by law.
Non-
# Printed Name Signature Member member
(check) (check)
1. _______________________________ ___________________________________ ____ ____
2. _______________________________ ___________________________________ ____ ____
3. _______________________________ ___________________________________ ____ ____
4. _______________________________ ___________________________________ ____ ____
5. _______________________________ ___________________________________ ____ ____
6. _______________________________ ___________________________________ ____ ____
7. _______________________________ ___________________________________ ____ ____
8. _______________________________ ___________________________________ ____ ____
9. _______________________________ ___________________________________ ____ ____
10. _______________________________ ___________________________________ ____ ____
11. _______________________________ ___________________________________ ____ ____
12. _______________________________ ___________________________________ ____ ____