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Waiver
Who is this registration for?
Please provide a name and email address for a parent or guardian, they will need to sign off for you.
Parent/guardian first name:
Parent/guardian email:
I desire to participate in the Adopt A Street Program (the “AAS”) being held throughout the year. As a condition to doing so, I agree to the following:
1. I am over the age of 18. [If not 18, parent or guardian signature required below.] I am familiar with AAS and the risks associated with participation in this activity and am willing to assume the risk of participating in AAS.
2. I understand that AAS is a community program held in Westfield, Indiana.
3. For myself and for my heirs, executors, administrators and any other person who might have a claim by or on my behalf, I hereby waive and forever release and discharge the City of Westfield and its elected officials, employees, staff and representatives, and each of them, of and from any and all claims, suits, liabilities, damages or causes of action of any kind which I or such other persons might have arising out of or in connection with my participation in AAS, including any personal property damage or personal injury of any kind which may be sustained or occur during my participation in the event, whether or not such injuries, property damage, or loss is caused by, is connected to, or arises out of any acts or omissions or the negligence of City of Westfield or any of its elected officials, employees, staff, or representatives.
4. I further agree to indemnify the City of Westfield and each of such other persons, and to hold each of them harmless, from any claim by any other person or entity, which might be asserted against them due to any of my actions or omissions in connection with my participation in the AAS.
I desire to participate in the Adopt A Street Program (the “AAS”) being held throughout the year. As a condition to doing so, I agree to the following:
1. I am over the age of 18. [If not 18, parent or guardian signature required below.] I am familiar with AAS and the risks associated with participation in this activity and am willing to assume the risk of participating in AAS.
2. I understand that AAS is a community program held in Westfield, Indiana.
3. For myself and for my heirs, executors, administrators and any other person who might have a claim by or on my behalf, I hereby waive and forever release and discharge the City of Westfield and its elected officials, employees, staff and representatives, and each of them, of and from any and all claims, suits, liabilities, damages or causes of action of any kind which I or such other persons might have arising out of or in connection with my participation in AAS, including any personal property damage or personal injury of any kind which may be sustained or occur during my participation in the event, whether or not such injuries, property damage, or loss is caused by, is connected to, or arises out of any acts or omissions or the negligence of City of Westfield or any of its elected officials, employees, staff, or representatives.
4. I further agree to indemnify the City of Westfield and each of such other persons, and to hold each of them harmless, from any claim by any other person or entity, which might be asserted against them due to any of my actions or omissions in connection with my participation in the AAS.
Check here to show you accept the terms stated above for yourself or for a minor volunteer for which you are a parental guardian.
I desire to participate in the Adopt A Street Program (the “AAS”) being held throughout the year. As a condition to doing so, I agree to the following:
I desire to participate in the Adopt a Street Program (“Activity”) being held ________________________. As a condition to doing so, I agree to the following:
1. I am 18 or over the age of 18 [If not 18, parent or guardian signature required below.] I am familiar with the Activity and the risks associated with participation in the Activity and am willing to assume the risk of participating in the Activity.
2. I understand that the Activity is an event held on the grounds of ____________________.
3. For myself and for my heirs, executors, administrators and any other person who might have a claim by or on my behalf, I hereby waive and forever release and discharge the City of Westfield and its elected officials, employees, staff and representatives, and each of them, of and from any and all claims, suits, liabilities, damages or causes of action of any kind which I or such other persons might have arising out of or in connection with my participation in the Activity, including any personal property damage or personal injury of any kind which may be sustained or occur during my participation in the Activity, whether or not such injuries, property damage, or loss is caused by, is connected to, or arises out of any acts or omissions or the negligence of City of Westfield or any of its elected officials, employees, staff, or representatives.
4. I further agree to indemnify the City of Westfield and each of such other persons, and to hold each of them harmless, from any claim by any other person or entity, which might be asserted against them due to any of my actions or omissions in connection with my participation in the Activity.
5. I further agree to adhere to all code of conduct procedures and policies set forth by the City of Westfield during participation in the Activity.
6. I hereby authorize and give my full consent to the City of Westfield, and its affiliates, officers, agents, employees, representatives, assigns, or successors, to take, copyright and/or publish any and all photographs, sound recordings, videotapes and/or film (the “Media”) in which I, or my child, may appear while participating in the Activity. I further agree that the City of Westfield may transfer, use, or cause to be used, the Media in any exhibitions, public displays, news releases, websites, blogs, publications, commercials, art, and for advertising purposes, without limitations or reservations and without providing monetary or other compensation to myself or my family.
7. I hereby verify that I, or my child, am/is in good physical health and able to participate in the Activity.