Hertel Clean Up Sign Up & Liability Release Form 2024

Hertel Clean Up Sign Up & Liability Release Form

Please read and fill out this form. Each member of your group needs to fill out their own form.
Name*

First NameLast Name
Business or Organization Represented
If applicable
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you need a letter for proof of community service hours?
If so, please list for what organization or school
In consideration of my desire to serve as a volunteer for the Hertel Business Association (HBA), I hereby assume all responsibility for any and all risk of property damage or bodily injury that I may sustain while participating in any voluntary effort and activity of any nature, including the use of equipment and facilities associated with any HBA clean-up event.

Further, I, for myself and my heir, executors, administrators and assigns, hereby release, waive, and discharge the HBA and its officers, directors, employees, agents, board members, members, and volunteers of and from any and all claims which I or my heirs, administrators and assigns ever may have against any of the above for, on account of, by reason of or arising in connection with such claims, demands and causes of action.

Further, I expressly agree that this release, waiver and indemnity agreement is intended to be as broad and inclusive as permitted by the State of New York, County of Erie, City of Buffalo, and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effort.

I currently have no known mental or physical condition that would impair my capability for full participation as intended or expected of me. Further, I have carefully read the foregoing release and indemnification and understand the contents thereof and sign this release as my own, free act.
Signature*

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