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<br /> <br /> <br /> <br />CERTIFICATION OF PERSON SUBMITTING <br />RELEASE OF CLAIMS FORMS FOR <br /> <br />__________________________________ <br />(Fill in name of group or organization) <br /> <br /> <br /> <br />I, ___________________________________________________________, am the <br />(Print full legal name) <br /> <br />____________________________ of the ______________________________________ <br /> (Title or position) (Name of group/organization) <br /> <br />and hereby certify that: <br /> <br />1. I have distributed a Release of Claims form to each participant; <br />2. I have explained to each participant that: <br />a. a completed, signed form must be submitted to P&R prior to any person (adult or minor) <br />participating in a P&R program or using a P&R facility; <br />b. any participant who has not submitted a signed Release of Claims form may not participate <br />in the P&R program and/or use the P&R facility; <br />3. I have reviewed each participant’s form for accuracy and completeness; <br />4. I have COPIES of all signed waiver forms and will have them with me or another group member at <br />all times that our group is using a P&R program or facility; <br />5. I am submitting all ORIGINAL waiver forms to P&R prior to the start date indicated on the waiver <br />form (unless prior written permission has been obtained from the County, a copy of which is <br />attached to this certification); <br />6. I understand I am responsible to notify all latecomers of this requirement, and to submit a signed <br />Release of Claims form prior to any latecomer’s participation; and <br />7. I will not allow any individual in my group/organization to participate if a Release of Claims form <br />has not been signed and submitted to the County prior to any individual’s participation or use of a <br />County program or facility. <br /> <br /> <br />_______________________________ ____________________________________ <br />Signature Witness Signature (Age 18 or older) <br /> <br />_______________________________ ____________________________________ <br />Date Printed Name <br /> <br />_______________________________ ____________________________________ <br />Address Address <br /> <br />_______________________________ ____________________________________ <br />Day Phone Number Phone Number <br /> <br /> Release of Claim - Certification Form - 5-23-06 <br /> <br />