Verification Number (Leave this blank):
September 16, 2017
Neighborhood Cleanup Location (if applicable) / Comments / Questions
Volunteer Release of Liability, Hold Harmless and Indemnification Agreement
In consideration of the opportunity to engage in volunteer work during the Neighborhood Litter Stomp, the undersigned, my heirs and assigns,
hereby waive all claims for injuries, damages or losses to my person or property which may be caused directly or indirectly, by any act, omission or
negligence of the Neighborhood Litter Stomp and/or the City of Fort Worth (“City”), their officers, agents and employees, in the execution of the
volunteer work. The undersigned, my heirs and assigns, hereby covenant and agree to indemnify and hold harmless the Neighborhood Litter Stomp and
the City, their officers, agents and employees, from any and all costs, charges, claims, demands, losses, damages, causes of action, suits and liabilities
of any kind, including the expenses of litigation, court costs and attorney’s fees, for injuries to, or the death or illness of any person, or for damage
to any property, arising out of or in connection with my involvement in the volunteer work, regardless of whether such injuries, illness, death or damages
are reasonably foreseeable or reasonably with the contemplation of the parties to this agreement. The undersigned, my heirs and assigns, hereby further
covenant and agree not to sue the Neighborhood Litter Stomp and the City, their officers, agents, and employees for any matter which arises from the
execution of the volunteer work.
I have read, understood, and accept the agreement above. My submission form shall act as my legal signature.
Initials of registrant if over 18 years of age, or parent/legal guardian of minor, incapacitated, or mentally-challenged person.