Uptown Propane Fire Pit Waiver

(Print Name)*

wish to borrow from Uptown Saint John Inc.

1 or 2 (fill in whether you want "one" or "two") propane fire pits*

Business Name that is requesting to use them *

Address of Business requesting *

Address of location the fire pits are being used at *

Start Date of uage *

Date

End date of usage*

Date

I understand and accept responsibility for the safe use, care, and storage of the fire pit(s) as they are in my possession. I accept all responsibility, both known and unknown to me. These responsibilities include, but are not limited to, safe usage (constant physical monitoring while in use, no foreign or flammable objects placed in the flame), fire extinguisher on hand, secure storage while not in use, and provide propane and tank.I acknowledge that I am responsible for any damages that may occur.

Uptown Saint John will deliver and pick up the fire pit(s) at a predetermined and agreed upon time within minimum lead time 48 hours notice. Uptown Saint John will also supply a fire extinguisher to have on hand.

I understand that Uptown Saint John Inc. does not provide insurance to cover any damages to our property.

On behalf of the above mentioned business, I understand that I will follow all fire requirements and rules. I hereby waive, release and discharge any and all claim of damages for personal injury or property damage which may sustained arising from any actions by the Uptown Saint John Inc. fire pits.

I have had sufficient time to review and seek explanation of the provisions contained above, have carefully read and understand them, and agree to be bound by them.

Company Representative*

Phone Number*

Date*

Date

The property owner has given permission for the fire pit to be used (Must be given to complete this form, write yes below once permission has been given)*

In order to request this service, all BIA levies must be paid in full, acknowledge and confirm that all BIA levies have been paid in full by writing below; "Yes, all BIA levies have been paid in full as of the date of application"*