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RELEASE, HOLD HARMLESS AND RESERVATION AGREEMENT

I,(print NAME) ___________________________________________hereby certify that I have volunteered to provide services to help St. BernardParish and its residents recover from the devastation of Hurricane Katrina. I acknowledge that the work, which I will perform as volunteer, is not under

the supervision or control of the St. Bernard Parish Government or any of its agents, employees, or contractors.I understand that during the period of volunteer work from (arrival date) _________________to (departure date) __________________ I will be

assigned to Camp Hope. I understand and acknowledge that the Camp will provide only the most basic shelter conditions. I understand and

acknowledge that there are additional health risks associated with living in the Camp, and agree to act accordingly at all times, and guard my safety and

the safety of other occupants of the Camp.

I agree to abide by the rules of the Camp and understand that failure to abide by the rules may be grounds for immediate removal from the Camp.I understand that in order to be sheltered in the Camp, St. Bernard Parish Government has collected my name, address, email address, and emergency

contact information. I hereby give our permission for the release of this information to appropriate federal or state government agencies, which may be

necessary in providing me assistance.I release and agree to hold harmless the St. Bernard Parish Government, Camp Hope, and any of their agencies, agents, contractors, subcontractors

and/or representatives for damages or losses of any type whatsoever that I may sustain arising from our participation as volunteers. I further release,

discharge, and waive any action, either legal or equitable, that might arise by reason of any action of the above entities, while providing lodging, meals

or other services or supplies to me during the period of my participation in recovery efforts in St. Bernard Parish.Please print, sign and have this document available upon arrival at Camp Hope

Print the Group Name if you are a member of a group: _________________________________________________________

Cell or other number: ( ) _____________________________Signature of Individual: ___________________________________________

Date: _______________________________Mailing Address: _______________________________________City: _______________________ ST: ____ Zip: __________

WITNESS SIGNATURE: _______________________________________________________Print Witness Name: __________________________________________________________

Witness Tit le: __________________________________________________________

Date: ______________________________

Witness Phone Number: ( ) __________________________________________

8/14/2019 Camp Hope Release and Waiver

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Please keep a copy of this document and bring the COMPLETED original with you when you arrive.