Hessville Clean Up

Hessville Clean Up

Oct 14, 2017

Participation Waiver

Please read this form carefully and be aware that in signing up and participating in this project you will be waiving and releasing all claims for injuries you might sustain arising out of this project. As a participant in this project, I recognize and acknowledge that there are certain risks of physical injury and I agree to assume the full risk of any injuries, including death, damage or loss that I may sustain as a result of participating in any and all activities connected with or associated with such program. I agree to waive and relinquish all claims I may have as a result of participating in this project against Hessville Commerce and Community Creative, and its officers, agents, servants and employees, and all sponsors, partners, participating agencies, companies, and all other program participants and volunteers. I, do hereby fully release and discharge Hessville Commerce and Community Creative, and its officers, agents, servants and employees, and all sponsors, partners, participating agencies, companies, and all other project participants and volunteers from any and all claims from injuries, including death, damage or loss which I may have or which may accrued to me on account of my participation in this project. I further agree to indemnify and hold harmless and defend Hessville Commerce and Community Creative and its officers, agents, servants and employees, and all sponsors, partners, participating agencies, companies, and all other project participants and volunteers from any and all claims resulting from injuries, including death, damage and losses sustained by me and arising out of, connected with, or in any way associated with the activities of this project. I HAVE READ AND FULLY UNDERSTAND THE ABOVE PROGRAM DETAILS AND WAIVER AND RELEASE OF ALL CLAIMS.

Participant Signature______

Participant Name (please print)______

Address______City______State______Zip______Phone______Emergency Phone______Participant’s Age______Date______Signature needed if a minor or under the age of eighteen, by parent or guardian. Guardian or Parent Signature______Guardian or Parent (please print)______Relationship______

YOUR COMMITMENT TO THIS PROJECT IS IMPORTANT TO US!