VOLUNTEER RELEASE OF LIABILITY
(For Participants Over Age 18)
ALL participants under the age of eighteen (18) MUST have a separate Release form signed by their parent or legal guardian.
As indicated by their signatures on this agreement, we (I) do hereby release and discharge the City of Cut Bank, and its officers, agents and employees from all claims, demands and causes of action of any kind whatsoever for any damages and/or injuries that may result from my participation in the Adopt-A-Block Program and/or volunteer activities occurring on or near City street right-of-way, on City property or in City buildings.
We (I) further agree to hold harmless the City of Cut Bank, and its officers, agents and employees from liability for any damages of injuries resulting from any negligence or willful wrongdoing on my part during my participation in said volunteer activities occurring on or near the City street right-of-way, on City property, or in City buildings.
As a prerequisite to participation in the Adopt-A-Block Program, I have read the Adopt-A-Block “Safety Rules and Guidelines”. Furthermore, I understand it is my responsibility to reread and review this document before my participation in each monthly Adopt-A-Block cleanup activity.
NAME |
ADDRESS |
DATE |
VOLUNTEER RELEASE OF LIABILITY
(For Participants Under Age 18)
Date of Event: _______________________________
Volunteer Organization: _______________________
All
participants under the age of eighteen (18) MUST have this release for
signed by
their parent or legal guardian!
I do hereby release and discharge the City of Cut Bank, and its officers, agents and employees from all claims, demands, and causes of action of any kind whatsoever for any damages and/or injuries that may result from my participation in the Adopt-A-Block Program and/or volunteer activities occurring on or near City street right-of-way, on City property, or in City buildings.
I further agree to hold harmless the City of Cut Bank, and its officers, agents and employees from liability for any damages or injuries resulting from any negligence or willful wrongdoing on my part during my participation in and volunteer activities occurring on or near the City street right-of-way, on City property or in City buildings.
As a prerequisite to participation in the Adopt-A-Block Program, I have read the Adopt-A-Block “Safety Rules and Guidelines”. Furthermore, I understand it is my responsibility to reread and review this document before my participation in each monthly Adopt-A-Block cleanup activity.
| _____________________________________ | _____________________________________ |
Minor’s Name (PLEASE PRINT) |
Minor’s
Address |
| _____________________________________ | |
Minor’s Signature |
|
| _____________________________________ | |
Date
of Signature |
I certify that I am the minor’s legal parent or guardian and herby grant permission from him/her to participate in the Adopt-A-Block Program or volunteer service program. I further agree to abide by the stipulations set forth in the above paragraphs.
| ____________________________________ | ____________________________________ |
Parent’s or Guardian’s Name (PLEASE PRINT) |
Parent’s
or Guardian’s Address (If different from minor’s) |
| ____________________________________ | |
Parent’s or Guardian’s Signature |
|
| ____________________________________ | |
Date
of Parent’s or Guardian’s Signature |
|
This form MUST be kept on file at the Cut Bank Beautification Committee Office.