Assumption of Risk & Release Form | Adopt-a-Street

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City of Simpsonville Event Liability Release & Photo Authorization for the Simpsonville SIMPLY PROUD. Adopt-a-Street Program

Are you the parent/legal guardian/responsible party of a volunteer who is a minor (under 18 years of age)? *
Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png txt rtf html pdf doc docx odt ppt pptx odp xls xlsx ods xml.
Agreement *
Statement
The Volunteer participating in the Simpsonville SIMPLY PROUD. Adopt-a-Street Program understands that he/she/they is engaging in activities that may expose him/her/they to dangers both from known risks and unanticipated risks. By signing this form the Volunteer discharges and holds harmless the City of Simpsonville and its representatives from any and all liability, claims, losses, suits, damages, and demands of whatever kind or nature arising or resulting from property damage, bodily or personal injury and/or death that may be caused by the City of Simpsonville's negligence or otherwise. By signing this form the Volunteer also understands that the City of Simpsonville, its partners, and affiliates may use all photographic images, video or audio recordings, video or audio reproductions, films, radio or television broadcasts and any other reproductions of the activities without limitations. Permission is granted for use in any medium now known or hereafter developed, including printed media, video, still photography and the Internet.
(e.g. Smith Family & Main Street)
Date of Cleanup
Date
Are you the designated contact person for the organization with which you are volunteering? *
Is a person under the age of 18 years old volunteering with you? *
Provide your best estimate.
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