Minnesota Mycological Society - Waiver Release Form

I (We) realize that when engaged in wild mushroom activities, that serious physical injury and personal property damage may accidentally occur. I (We) further realize that there is always the possibility of having an allergic reaction to or being poisoned by the eating of wild mushrooms and that these adverse reactions to eating wild mushrooms range from mild indigestion to fatal illness.

Knowing the risks, I (We) agree to assume the risks and agree to release, hold harmless, and indemnify the Minnesota Mycological Society and any officer or member thereof, from any and all legal responsibility for injuries or accidents incurred by myself or my family during or as a result of any mushroom identification, field trip, excursion, publication, meeting, or dining sponsored by the club.

Name (print):_____________________ Signature: _______________________Date: ________

Name (print):_____________________ Signature: _______________________Date: ________

Name (print):_____________________ Signature: _______________________Date: ________

Received by MMS Representative: ____________________________________ Date: ________

Instructions:

  1. Print out this form.
  2. Read and Understand the Waiver Agreement.
  3. Sign and date the form.
  4. Return to the Membership secretary. You can bring it to any club meeting or event or you can return your form via mail:

Return Form to:

Minnesota Mycological Society
PO Box 14424
St. Paul, MN 55114

Rev 1.2web - 2007.12.30