Participant Name *

First Name

Last Name

Phone

(###)

###

####

Waiver of liability *

THIS WAIVER OF LIABILITY ("Waiver") is made and entered into on this date by and between the individual indicated on this form ("Participant") and ACRN ("Nonprofit"). 1. Acknowledgment of Risks The Participant acknowledges that transportation to detox and residential recovery programs involves inherent risks, including but not limited to, the risk of accident, injury, or emotional distress. The Participant voluntarily assumes all such risks. 2. Waiver of Liability In consideration for being provided transportation services by volunteers of the Nonprofit, the Participant hereby releases, waives, and discharges the Nonprofit, its officers, directors, employees, agents, and volunteers from any and all claims, demands, actions, and causes of action arising out of or relating to any injury, loss, or damage incurred during transportation. 3. Indemnification The Participant agrees to indemnify and hold harmless the Nonprofit from any claims brought by third parties arising out of the Participant’s participation in this transportation program. 4. Governing Law This Waiver shall be governed by and construed in accordance with the laws of the State of North Carolina. 5. Severability If any provision of this Waiver is found to be unenforceable or invalid, the remaining provisions shall remain in full force and effect. 6. Acknowledgment of Understanding The Participant acknowledges that they have read this Waiver, understand its contents, and voluntarily acknowledge it.

Acknowledge