Observer Release

Your Information
Name *	Email *	Date of Birth *
Street Address *
City *	State *	ZIP Code *

Emergency Contact Information
Who to Contact	Relationship to you	Their phone number
Their Home Address *
City *	State *	ZIP Code *

Have you purchased your personal insurance

Have you given a copy of the personal insurance to Jimmy Donnelly?

Attach a file

Know all persons these presents, that I, ____________________________ residing at ______________________________, being over the age of eighteen in consideration of being permitted to participate in the Training Program of Volunteer Heart Resuscitation Unit D/B/A Volunteer Heart Ambulance, hereby agree to abide by all rules and regulations of Volunteer Heart Ambulance and for myself and my heirs, executor, administrator, and assigns do hereby remise, release, and forever discharge Volunteer Heart Ambulance, successors and assigns, directors and officers, agents, and all other persons, firms and corporations of from any and all claims, demands, rights and causes of action of whatsoever kind and nature, arising from or by reason of any and all known and unknown , foreseen and unforeseen injuries or damages, or the consequences thereof, of whatsoever nature, arising out of or incurred in any way in connection with my participation with Volunteer Heart Ambulance. In Witness Whereof, I have hereunto executed this release on this, the date of

Today's Date

By checking here, you are e-signing the above release form.

Join Volunteer Heart Ambulance Today

Or make a donation

Become a Member

Donate

Observer Release

Your Information

Emergency Contact Information

Join Volunteer Heart Ambulance Today

Or make a donation