Pearl River County Leadership Program

I understand the mission and goals of the Pearl River County Leadership Program. I understand the time commitment required of me as a program participant. If selected, I commit to attend all monthly sessions, and I fully understand that should I miss more than 1 unexcused session, I may be dismissed from the program with no portion of my tuition refunded. (You are allowed 1 excused absence) I understand that I will be required to work on and complete a group project. I am willing to devote my time and energy to the sessions, my project and the program as a whole. I understand that successful follow-through of these commitments is dependent upon completion of the program. I further understand that this is a competitive selection process and due to space limitations, not all applicants can be selected. I, being of legal age, hereby consent, that my name, image, and likeness, as shown in the videotapes, photographs, film, recordings, electronic images, plates, tapes and software in which I appear, and/or audio recording made of my voice may be used by the Pearl River County Leadership Program, its assigns or successors, in whatever way they desire. Furthermore, I hereby consent that such shall be the property of the Pearl River County Leadership Program, and they shall have the right to sell, duplicate, reproduce and make other uses of such videotapes, photographs, film, recordings, electronic images, plates, tapes and software as they may desire free and clear of any claim whatsoever on my part.

Thank you for agreeing to participate in the Pearl River County Leadership Program. During your volunteer activities with the program, if a serious injury should occur that requires emergency medical assistance, you are required to report the incident to your health insurance provider first. WAIVER OF LIABILITY: I acknowledge that I or my dependent(s) have voluntarily applied to participate with the Pearl River County Leadership Program on any of its projects without pay as a volunteer and agree that we are assuming the risk of injury or loss of life by participating. I or my dependent(s) understand that I/they are voluntarily participating in various individual and group activities related to the mission of the program. This release is intended to be broad in its effect. I hereby agree to accept any and all risk of injury, illness or death and verify this statement by placing my signature below. As consideration for being permitted to participate in these activities, I, on behalf of myself, my heirs, legal guardians, representatives and dependents, hereby irrevocably and unconditionally waive, release and forever discharge Greater Area Picayune Chamber (GAPC), its officers, directors, agents and representatives from any and all claims, demands, causes of action, damages, actions, judgments, liens, losses, costs, attorney’s fees and legal expenses or liabilities of any nature (including injury to and/or death of the participant), whether negligent or intentional, resulting from participation by me or my dependents in said activities.