Wuffingas hopeful, COPY AND PRINT OUT THIS WAIVER. Do not alter or change it in any way, shape, or form.
SIGN
IT AND DATE IT.
HAVE IT NOTARIZED, AND SEND IT TO THE;
CLERK
OF THE ROSTER
SECRETARY OF WUFFINGAS
11571 WEST US HIGHWAY 40
CAMBRIDGE CITY INDIANA 47327
IF YOUR DUES ARE NOT CURRENT THE WAIVER CANNOT BE ACTIVATED UNTIL THEY ARE.
Copy below in it's entirety.
WAIVER AND INFORMED CONSENT TO PARTICIPATE
IN
Wuffingas Inc. Events & MARTIAL ACTIVITIES.
PLEASE PRINT ALL
INFORMATION CLEARLY
I, ________________________________, (Full Legal
Name Please Print)
As it appears on your birth certificate and/or Drivers license.
______________________________________________(Street
Address)
,
(City) (State) (Postal Code)
________-__________-______________
Home Day Phone/cell No work numbers please.
__________________________________________________
*e-mail,
*(An e-mail account is optional for members with no Office
or Title, or who do not own a computer. Mandatory for Officers, Royalty, Knights, Squires, Man at Arms, or Page. Members
without computers will have to be disadvantaged and held to "snail mail" time laps.
Having
read and understood the content of ALL Wuffingas Reenactment Society Inc. documents, In full knowledge and in sound mind and
body, do therefore agree and consent to the provisions contained herein.
It
is my intention and desire to fully participate in & at Wuffingas Events, to include: full contact mock combat-related
activities such as in a regulated sport not unlike Hockey, Football, Soccer, Boxing, and all recognized Martial arts. I furthermore
wish to participate of my own free will and determination: armed combat, period fencing, marshaling, combat archery, scouting,
brewing, banner-bearing, Equestrian, Heraldry, Siege, Firearms Shooting, Thrown Weapons, and as an active Spectator of the
same, Etc as I see fit, to be held at Events, Science Fairs, Mock War, Feasts, Courts, Demonstrations, Learning Projects,
etc,...held by the Wuffingas Reenactment Society, Incorporated.
I
hereby acknowledge that I am fully aware of the nature and purpose of the activities of the Wuffingas Reenactment Society,
Inc.
I acknowledge that these activities are potentially dangerous and that I voluntarily accept any risks involved.
I realize that real and actual physical injury is a staple of such martial arts. In consideration for my being permitted
to take part in these activities, I agree to be bound by the rules for and of; The Wuffingas Reenactment Society, Inc. and
to obey the directions of the Judges, Referee's, Marshals, Safety Officers, Royalty, and other governing Officials of activities
at all time and to the letter. In the event of any disagreements or disputes arising from my taking part in these activities,
I agree to submit such disagreements or disputes to a board of arbitration appointed by the WRS, Inc. and to abide by any
decisions reached by such board.
Furthermore, I agree to release, hold harmless, and keep indemnified the
Wuffingas Reenactment Society Incorporated, as well as it's Organizers, Agents, Officials, Servants, Employee's, and Representatives
from and against all claims, actions, costs, expenses and demands in respect to death, injury, loss or damage to my person
or property, howsoever caused, arising out of or in connection with my taking part in these events even if the same may have
been contributed to, or occasioned by, the negligence of the said body: or any of its Agents, Servants or Representatives.
It is understood and agreed that this agreement is to be binding on heir's executor's assigns and myself.
Legal Legible Signature Date
/ / .
Print
Wuffingas Persona Name, Kingdom, and Rank at signing.
_________________________________________________________
__________________________________________
(Signature of Witness)
__________________________________________
(Signature of Witness)
Yes No LEGAL SIGNATURE
INSTRUCTIONS FOR USE This waiver MUST be SIGNED, DATED, and WITNESSED. It MUST
be sent in with your Kingdom Level first time Authorization Tracking Form to the Clerk of the Wuffingas Roster.
This waiver need not be re-executed if you are authorized for additional field
activities
THIS WAIVER ALONE DOES NOT AUTHORIZE YOU TO PARTICIPATE IN COMBAT-RELATED ACTIVITIES. YOU MUST COMPLETE
THE AUTHORIZATION PROCEDURES, i.e., Written-test, and Prowess Check. File your Medical Card with the Clerk, and have said
Notarized.
Revised
June 12, 2007 Copy-write Robert P. Shyan-Norwalt
Revised December 16th 2007, Copy-write Robert P. Shyan-Norwalt
