Please read the form below. Indicate your intention to sign this form prior to departure on the Topaz volunteer
in the framework of__where ever you may go – Poland 2022 relief operation.
1. understand and agree that neither Topaz nor its staff may be held liable in any way for any occurrence in connection with this program which may result in injury, or damages to me.

2. In consideration of being allowed to undertake this immersion, I HEREBY PERSONALLY ASSUME ALL RISKS in connection with the program, for any harm, damage, injury or death, which occur while I am participating in the program, including without limitation, all risks connected herewith, whether foreseen or unforeseen.

3. I, as a participant, recognize and understand the risks involved and I accept these risks as my own and it is my intention, by this document, to EXEMPT AND RELEASE TOPAZ AND IT'S STAFF from all liabilities.

4. I further state that I am of lawful age and legally competent to sign this affirmation and release, or that I have acquired the written consent of my parents or guardians; that I UNDERSTAND THE TERMS HEREIN ARE CONTRACTUAL and not a mere recital, and that I have signed this document of my own free will.

5. I further acknowledge that this document may be relied upon in any proceedings instituted in any Court by me or my heirs, executors and assigns.

6. The information that I have provided is accurate to the best of my knowledge. I verify that I am physically fit, not under the influence of alcohol or drugs at this time and sufficiently qualified to VOLUNTEER in where ever you may go – Poland 2022 relief operation.