Freedom Sticker Individual Consent Form


Freedom Sticker Hero (1)

Before you have access to order the Freedom Sticker Packet we need you to sign the individual consent form below. Once you sign the form you will be redirected to the Freedom Sticker order form. Please let us know if you have any questions: info@inourbackyard.org

In consideration of being permitted to participate in activities conducted under the auspices of In Our Backyard (“IOB”) to counteract the trafficking of humans (the “Covered Activities”), the undersigned hereby (i) agrees to obtain from the proprietor of any business or location in which said stickers are placed a signed consent and waiver in IOB’s standard form, and (ii) for itself and its members, managers, officers, directors, employees, agents, representatives and others acting by or through them (collectively, “Releasors”),waives and releases all claims and rights that the undersigned may have

now or in the future against IOB and its members, managers, officers, directors, employees, agents, representatives and others acting by or through them, including but not limited to Benita Belles, Daniel Belles, World Impact Network and Majestic Views Unlimited, LLC (each, a “Releasee”) arising out of or in connection with (a) any accident or injury (including death) to the undersigned or any other person or damage to any property arising from or related to Covered Activities, or (b) any act, error, omission, fault, negligence or strict liability of any Releasee in connection with Covered Activities, and (iii) agrees not to bring any lawsuit or file any charge or claim against any Releasee in any court or before any government agency related to Covered Activities.

I have read and I understand the above Agreement and release for In Our Backyard. I agree to abide by the rules described above and understand that I may be removed as a participant if I violate any of these rules.

Phone Number:  

How did you hear about In Our Backyard?

Once this document is signed you will be given the opportunity to make a donation towards the cost of shipping and handling of the Freedom Sticker packet. We appreciate any donation you can make towards the fight against human trafficking.

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In Our Backyard http://inourbackyard.org
Signature Certificate
Document name: Freedom Sticker Individual Consent Form
Unique Document ID: 183858bc6990dc31ec4833c28ad4c187d4d72f88
Timestamp Audit
2016-07-13 13:23:54 PSTFreedom Sticker Individual Consent Form Uploaded by Nita Belles - info@inourbackyard.org IP 216.54.31.82