Waiver Release Form

Roster of Participants and Waiver Agreement

The following persons are participating in in this trip with Catch A Smile:

______________________________ ___________________________

______________________________ ___________________________

______________________________ ___________________________

_____________________________ ___________________________

_____________________________ ____________________________

Organization: ________________________________________________________

Location: ___________________________________________________________

I, _________________________, have read and agree to the terms and conditions of the

Catch A Smile waiver. In addition I have the authority to accept these terms and

conditions on behalf of the participants listed above.

Signature:_____________________________ Date _____________________