Clean Drains Fort Wayne CHALK ART PHOTO UPLOAD 2023

Neighborhood Name*

Example: Northside Neighborhood, Mount Vernon Park, Packard Park, etc.

Your Name*

First NameLast Name

Your Email*

example@example.com

Your Phone*

Please enter a valid phone number.

PLEASE UPLOAD YOUR DRAIN ART PHOTOS!*

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Maximum of 3 photos

Please list the names of the individuals in the photos (if applicable):

First and Last Name

WAIVERS & CONSENT TO PARTICIPATE*

By checking this box, you acknowledge and agree you are participating in the 2022 Clean Drains Program (“Program”) on a voluntary basis and your participation may involve risks inherent to the activities being undertaken in connection with the Program. You acknowledge that you knowingly and willingly accept such risks and that the City of Fort Wayne and Friends of the Rivers shall have no liability related to your participation in the Program whatsoever. By checking this box, you agree to release, discharge, and hold harmless the City of Fort Wayne and Friends of the Rivers, and each of their respective employees, agents, and representatives, of and from all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating to your participation in the Program, whether as a result of bodily injury, property damage, or death. You further acknowledge that this release includes any claims, actions, damages, costs or expenses based on the actions, omissions, or negligence of the City of Fort Wayne and Friends of the Rivers, and each of their respective employees, agents, and representatives.I grant Friends of the Rivers permission to use the photo(s) which I have submitted which may include my likeness and/or the likeness of my minor child(ren),including my photograph in any and all publications, including but not limited to all of Friends of the Rivers printed and digital publications. I understand and agree that any photograph using my likeness or the likeness of my minor child(ren) will become property of Friends of the Rivers and will not be returned. I acknowledge that since my participation with Friends of the Rivers is voluntary, I will receive no financial compensation. I acknowledge that I am the legal guardian of those who are pictured in the image(s) I provided. I legally give consent for their image to be used by Friends of the Rivers for printed and digital publications. I hereby irrevocably authorize Friends of the Rivers to edit, alter, copy, exhibit, publish or distribute photos of me, my child(ren), and or including me, for the purposes of publicizing Friends of the Rivers programs or for any other lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph(s) for myself or my child(ren). I hereby hold harmless, release and forever discharge Friends of the Rivers from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

For more information contact Irene Walters at irenewalters1@gmail.com.

2023 CLEAN DRAINS FORT WAYNE