Survey Creation

Acknowledgement of Survey Volunteer Responsibility, Express

Assumption of Risk, and Express Release of Liability

In consideration for being allowed to participate as a volunteer in the Albuquerque Heading Home, City of Albuquerque, and Metropolitan Homeless Project on behalf of myself and my next of kin, heirs and representatives, I release from all liability and promise not to suethe Albuquerque Heading Home, City of Albuquerque, and Metropolitan Homeless Project and collectively its’ contractors, employees, officers, directors, volunteers and agents(“Survey Process Leadership”) from any and all claims, including claims of negligence, resulting in any physical or psychological injury (including paralysis and death), illness, damages or economic or emotional loss I may suffer because of my participation in the Survey Process, including travel to and from and during the Survey Process.

I am voluntarily participating in the Survey Process. I am aware of the risks associated with traveling to/from and participating in Survey Week, which include but are not limited to physical or psychological injury, pain, suffering, illness, disfigurement, temporary or permanent disability (including paralysis), economic or emotional loss, and/or death. I understand that these injuries or outcomes may arise from my own or other’s actions, inaction, or negligence; conditions related to travel; or the condition of the Survey Process location(s). Nonetheless, I assume all related risks, both known or unknown to me, of my voluntary participation in the Survey Process, including travel to, from and during the Survey Process.

I agree to hold the Survey Process Leadership harmless from any and all claims, including attorney’s fees or damage to my personal property that may occur as a result of my voluntary participation in the Survey Process, including travel to, from and during the Survey Process. If the Survey Process Leadership incurs any of these types of expenses, I agree to reimburse the Survey Process Leadership. If I need medical treatment, I agree to be financially responsible for any costs incurred as a result of such treatment. I am aware and understand that I should carry my own health insurance.

In consideration for my acceptance as a participant the Survey Process, and the services and amenities to be provided by theSurvey Process Leadership in connection with the Survey Process, I confirm my understanding that:

  • I have read any rules and conditions applicable to the Survey Process made available to me and I acknowledge my participation is at the discretion of the Survey ProcessLeadership.
  • TheSurvey Processofficially begins and ends at the location(s) designated by the Survey Process Leadership. The Survey Process does not includecarpooling, transportation, or transit to and from the Survey Process, and I am personally responsible for all risks associatedwith this travel.
  • If I decide to leave early and not to complete theSurvey Process as planned, I assume all risks inherent in my decision toleave and waive all liability against the Survey Process Leadership arising from that decision. Likewise, if the Survey Process Leadership has concludedthe Survey Process, and I decide not to return to the end location designated by the Survey Process Leadership, I assume all risks inherent in my decision to go forwardand waive all liability against theSurvey WeekLeadership arising from that decision.
  • This Agreement is intended to be as broad and inclusive as is permitted by law. If any provision or any part of anyprovision of this Agreement is held to be invalid or legally unenforceable for any reason, the remainder of thisAgreement shall not be affected thereby and shall remain valid and fully enforceable.
  • To the fullest extent allowed by law, I agree to WAIVE, DISCHARGE CLAIMS, AND RELEASE FROM LIABILITYthe Survey Process Leadership, its officers, directors, employees, agents, and leaders from any and all liability on account of, or inany way resulting from Injuries and Damages, even if caused by negligence of theSurvey Process Leadership, its officers, directors,employees, agents, and leaders, in any way connected with the Survey Process. I further agree to HOLD HARMLESS theSurvey Process Leadership, its officers, directors, employees, agents, and leaders from any claims, damages, injuries or lossescaused by my own negligence while a participant in the Survey Process. I understand and intend that this assumption of riskand release is binding upon my heirs, executors, administrators and assigns.
  • I have read this document in its entirety and I freely and voluntarily assume all risks of such Injuries and Damagesand notwithstanding such risks, I agree to participate inthe Survey Process.

Ido hereby consent and agree that the Survey Process Leadership, its employees, or agents have the right to take photographs, videotape, or digital recordings of me beginning on Sunday, January 30th, 2011 at 12:00 p.m. and ending on Friday, Feb 4th2011 at 3 p.m. and to use these in any and all media, now or hereafter known, and exclusively for the purpose of the Survey Process Leadership. I further consent that my name and identity may be revealed therein or by descriptive text or commentary.

I do hereby release to the Survey Process Leadership, its agents, and employees all rights to exhibit this work in print and electronic form publicly or privately and to market and sell copies. I waive any rights, claims, or interest I may have to control the use of my identity or likeness in whatever media used.

I am 18 years or older. I understand the legal consequences of signing this document, including (a) releasing the Survey Process Leadership from all liability, (b) promising not to sue the Survey Process Leadership, (c) and assuming all risks of voluntarily participating in the Survey Process, including travel to, from and during the Survey Process.

I understand that this document is written t o be as broad and inclusive as legally permitted by the State of New Mexico. I agree that if any portion is held invalid or unenforceable, I will continue to be bound by the remaining terms.

I have read this entire document and I am signing it freely. No other representations concerning the legal effect of this document have been made by me.

Participant’s Signature:______

Participant’s Name: ______Phone: ______

Address: ______Email: ______

Emergency Contact / Phone: ______