Release Form Name of Participant(Required) First Last Email(Required) Participant Phone Number(Required)Participant Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Name of organization/school/class/etc.(Required)Emergency Contact Name(Required) First Last Emergency Contact Phone Number(Required)RESPONSIBILITY AND MEDIA RELEASE: RESPONSIBILITY RELEASE: As a participant of a volunteer program/retreat/field trip/tour/course/class/workshop or other activity at the World Hunger Relief Farm, I wish to make clear my understanding that World Hunger Relief, Inc., P.O. Box 639, Elm Mott, Texas 76640, does not assume any responsibility for loss of property, damage to the same, personal harm or illness that may occur; and I, for myself, my heirs, executors, administrators, distributes, and assigns, in considerations, do hereby absolve World Hunger Relief, Inc. and hold them harmless from any claim of demand which I or they might conceivably assert upon the basis of the foregoing. WARNING: UNDER TEXAS LAW (CHAPTER 75A, CIVIL PRACTICE AND REMEDIES CODE), AN AGRITOURISM ENTITY IS NOT LIABLE FOR ANY INJURY TO OR DEATH OF AN AGRITOURISM PARTICIPANT RESULTING FROM AN AGRITOURISM ACTIVITY. MEDIA RELEASE: I hereby grant World Hunger Relief Inc to take photographs of me in connection with the volunteer program/retreat. I authorize World Hunger Relief Inc to copyright, use, and publish the same in print and/or electronically. I agree that World Hunger Relief Inc may use such photographs of me with or without my name and for any lawful purpose, including for such purposes as publicity, illustration, advertising, and Web content.Consent Signature(Required)PhoneThis field is for validation purposes and should be left unchanged.