LEGAL NAME EXACTLY AS IT APPEARS ON YOUR PASSPORT

 
Address *
Address
Cell Phone *
Cell Phone
Birthday *
Birthday
Expiration Date *
Expiration Date
Emergency Contact Number (cell) *
Emergency Contact Number (cell)
GENERAL RELEASE *
In consideration of acceptance of my application and allowing me to serve as a volunteer to and on behalf of CWE, I, for myself and my personal representatives, heirs, and assigns, hereby forever release, discharge and hold harmless CWE and its officers, directors, employees, agents and their respective heirs, representatives, successors and assigns, and each of them, from liability of any nature whatsoever, at law or in equity, including, without limitation, my participation as a volunteer. The validity, construction, and enforceability of this release shall be determined in accordance with the laws of the State of Florida.
Date *
Date