FIELD HEALTH SURVEY WAIVER

I, [your name], hereby acknowledge that I will be participating in a field health survey at [location]
organized by [name of organization] starting on [date] and ending on [date].

I understand that conducting a field health survey involves certain risks and hazards, including but not
limited to, exposure to infectious diseases, adverse weather conditions, and accidents.

I acknowledge that [name of organization] has taken all reasonable measures to ensure the safety of its
participants and that appropriate safety protocols and guidelines will be followed during the survey.
However, I also understand that there are inherent risks associated with fieldwork that cannot be
eliminated completely.

By signing this waiver, I acknowledge that I am solely responsible for my own safety during the field
health survey. I understand that I am expected to comply with all safety protocols and guidelines
provided by [name of organization] and to take reasonable precautions to prevent injury or harm to
myself and others.

I agree to release and hold harmless [name of organization], its employees, agents, and affiliates from
any and all liability for any injuries, illnesses, or damages that may occur as a result of my participation in
the survey.

I further agree to report any incidents or accidents that may occur during my participation in the survey
and to follow any instructions provided by [name of organization] regarding my health and safety.

I understand that this waiver is binding and that I am legally responsible for any actions I take while
participating in the field health survey.

Signed:

[Your Name]

Date: [Date]