I wish to help in the litter cleanup of Wake County’s and the Town of Holly Springs’ roadways. I agree that access to litter free roadways provides a benefit to me, my family, and other citizens. I understand that there are dangers and risks inherent in participating in the cleanup of our roadways including, but not limited to, the risk of bodily injury, disability and death. I understand that participating in this litter cleanup activity may involve risks including, but not limited to, exposure to inclement weather or excessive heat, falling debris, proximity to damaged trees or structures, accidents while traveling, injuries from the use of power tools and machinery, equipment problems or failures, proximity to vehicles or equipment (including those producing debris or dust), contact with and actions of other participants, slips/trips/falls, musculoskeletal injuries, harm from contact with sharp objects or tools, contact with chemicals or irritants, exposure to wildlife (including snakes and biting insects), and exposure to, and potentially contracting, COVID-19. I choose for myself or for my child to participate in this litter cleanup activity despite the risks.
By signing this form, I acknowledge all risks of injury, illness, and death and affirm that I have assumed all responsibility of injury, illness, or death in any way connected with participation in this litter cleanup activity. I also agree for myself and for any child participant to follow all rules and procedures that apply to the activity and to follow the reasonable instructions of County staff, of Town of Holly Springs staff, or other supervisors of the activity.
In return for the opportunity described above, I agree for myself and for my heirs, assigns, executors, and administrators to release, waive, and discharge any legal rights I may have to seek payment or relief of any kind from Wake County and its employees or agents, and from the Town of Holly Springs and its employees or its agents, for injury, illness, or death resulting from the litter cleanup activity. If I am allowing a child to participate in the litter cleanup activity, I agree that I am a parent, legal guardian, or am otherwise responsible for the child who is participating, and I agree that I will personally supervise the child during the activity. I also agree not to sue Wake County, its employees, or its agents, or the Town of Holly Springs, its employees, or its agents, and I agree to indemnify Wake County and the Town of Holly Springs for all claims, damages, losses, or expenses, including attorney’s fees, if a suit is filed concerning an injury, illness, or death to me or to my child resulting from participation in this litter cleanup activity.
I understand that neither Wake County, the Town of Holly Springs, nor any Wake County municipality provide insurance or worker’s compensation coverage for me or for my child. I have read this document thoroughly and understand that by signing this form I am waiving legal rights.
I hereby give permission to Wake County, to the Town of Holly Springs, and/or to their respective individual departments to prepare, use, reproduce, publish, re-publish, and exhibit my name, picture, portrait, likeness, or voice, or any or all of them in Wake County’s and/or the Town of Holly Springs’ public relations, marketing, and educational programs through any form of media, including but not limited to television, radio, cable, print, audio, or the Internet, in perpetuity, without compensation to me. Any photograph, photo transparency, drawing or other illustrative graphic material, audio-visual tape or audio illustration may be used without my prior examination of the finished product.