Appendix C: Liability Waiver

Toledo Area Disaster Medical Assistance Team

Liability Waiver

Whereas, being a DMAT applicant, guest, associate or inactive member of the Toledo Area Disaster Medical Assistance Team (OH-1), I would like to participate in the training titled: _________________________________________________________.

I fully understand and accept that the National Disaster Medical System has not completed processing an application under my name, therefore I cannot be covered by NDMS Workers Compensation or Federal Claims Tort Act.

Print Name

I, __________________________________________________, understand that I am volunteering to participate in this training and therefore will not hold the Toledo Area Disaster Medical Assistance Team (OH-1), it's sponsors, or any instructors or other participants in this training responsible for any accidental injury that may occur to me while traveling to, participating in, or returning from the training event. I also accept that due to the nature of some of the training events this team participates in, for my own safety, I may be asked to observe rather than participate.

Signed: _____________________________________________________________________________

Date: _______________________________

Witnesses:

_________________________________________________________ Date: ____________________

_________________________________________________________ Date: _____________________