Fort Wayne Newcomers Oldtimers & Natives

Name *

First

Last

Email *

Street Address *

City , State, Zip Code *

Main Phone Number *

Directory listing *

Birthday (MO/DAY)

Relocated From:

City, State and Country prior to relocation

Children

number and ages of children

Activities of Interest

How did you hear about Fort Wayne Newcomers? *

Facebook

Yes I am on Facebook
No I am NOT on Facebook

Waiver, Indemnity and Hold Harmless Agreement *

In consideration of being permitted to participate in Newcomers Club of Fort Wayne, Inc. ("Newcomers Club") whether as a member, non-member or otherwise, the Undersigned/Legal Guardian does fully comprehend and assume any and all risk of injury which might be associated with or result from participation in Newcomers Club activities or events, whether they now be known or unknown. The Undersigned/Legal Guardian Acknowledges that they have made a voluntary choice to participate in Newcomers Club activities or events with the risks that they may present, including the choice whether to use appropriate safety equipment.
The Undersigned/Legal Guardian, being fully cognizant, and assuming all risks involved in activities or events offered by Newcomers Club, does hereby remise, release, quitclaim and forever discharge Newcomers Club, its employees or agents, owners, officers, directors, members, volunteers, affiliates, sponsors, administrators, successors and assigns, of and from any and all manner of actions, suits, debts, accounts, damages, expenses, liabilities, judgments, executions, claims, our demands whatsoever in law or equity, arising out of personal injury, property damage, wrongful death or otherwise, including claims arising from conduct that would otherwise be active or passive negligence and/or recklessness, which against Newcomers Club the Undersigned/Legal Guardian, their heirs, executors, administrators, or assigns hereafter can, shall or may have, for, upon, or by reason of any damages that they or their minor child(ren) may sustain or incur while supporting or participating in any activity or event affiliated with Newcomers Club, including but not limited to, any and all meetings, interest group activities or special events, including travel to and from any such activity or function either alone or with others.
The Undersigned/Legal Guardian further declares and represents that in executing this instrument, the undersigned relies wholly upon their own judgment and that no representations, opinions, or statements made by Newcomers Club has influenced the Undersigned/Legal Guardian to any extent.
The Undersigned/Legal Guardian further states that this instrument contains the entire agreement between the parties; that the terms hereof are contractual and are not a mere recital; that the Undersigned/Legal Guardian has carefully read this instrument or that it was read to the Undersigned/Legal Guardian; and the Undersign ed/Legal Guardian understands its terms and signs the same as their own free act, and that it is the intention of the Undersigned/Legal Guardian by executing this instrument, to exempt and relieve Newcomers Club from any and all liability as stated herein, thereby allowing Newcomers Club to avoid liability and more efficiently continue its worthwhile mission.

*****Agreement to the above stipulations is a requirement of membership in the Fort Wayne Newcomers organization. If you agree to abide by these stipulations please indicate so by entering your name in the space provided below. By so doing and submission of this form it is taken that entry of this name is equal to and a substitute for a handwritten signature.

Name *

First

Last

Entry of your name in the above boxes is indicates acceptance of the Waiver, Indemnity and Hold Harmless Agreement in total as set down and stipulated and is accepted as equal to and a substitute for a handwritten signature whether entered by you or a person unknown to you.

Date: *

Enter the date completed and submitted.

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New Member Application

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