Town Clean-Up Volunteer Sign-Up
Share your contact details, emergency contact info, and your availability for the Town Clean-Up Program. Volunteers MUST also sign the wavier to volunteer. You will NOT be asked to volunteer unless the waiver is signed/submitted. This includes each member of your group/organization.
Full Name
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First Name
Last Name
Email Address
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example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Are you under 18?
*
Yes
No
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Which activity are you interested in volunteering for?
*
Tree/branch clean up
Cutting trees or branches
Providing a truck or trailer
General yard clean up
Do you have any tools or equipment you are willing to use?
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Yes
No
If yes, what tools or equipment will you bring:
Are you with a group or organization?
*
Yes
No
How many are with your group/organization?
When are you available to help?
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WAIVER & RELEASE AGREEMENT
Town of Chesterton Clean-Up Program Volunteer Waiver and Release of All Claims
Please read this form carefully and be aware that in signing up and participating in the Town Clean-Up Program (“Program”) you will be waiving and releasing all claims for injuries you might sustain arising out of this Program. THIS IS A LEGAL DOCUMENT THAT AFFECTS YOUR LEGAL RIGHTS.
THIS IS A RELEASE AND WAIVER OF LIABILITY FOR:
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First Name
Last Name
hereinafter referred to as “Participant”. Participant desires to participate in the Town of Chesterton (the “Town”) Town Clean-up Program by working as a volunteer for the Town, and to engage in the activities related to being a volunteer (the “Activities”). The Participant understands that the Activities may include removing trees, limbs, branches, and other vegetation, which may involve the use of power tools; and may also include bending, twisting, stooping, lifting, carrying, overhead reach, and other potentially strenuous movements.
Participant hereby freely, voluntarily, and without duress executes this Waiver and Release under the following terms: 1. RELEASE and WAIVER: Participant does hereby release and forever discharge and hold harmless Town, its boards, officers, and employees, and any successors or assigns thereof, from any and all liability, claims, and demands of whatever kind or nature, either in law or in equity, which arise or may hereafter arise from Participant’s Activities with Town. Participant understands and acknowledges that this Release discharges Town from any liability or claim that the Participant may have against the Town with respect to any bodily injury, personal injury, illness, death, or property damage that may result from Participant’s Activities with the Town, whether caused by the negligence of the Town or its officers directors, boards, employees, or agents, or otherwise. Participant also understands that the Town does not assume any responsibility for or obligation to provide financial assistance or other assistance, including but not limited to, medical, health, or disability insurance in the event of injury, illness, death, or property damage. 2. MEDICALTREATMENT: Participant does hereby release and forever discharge the Town from any claim whatsoever which arises or may hereafter arise on account of any first aid, treatment, or service rendered in connection with the Participant’s Activities with the Town. 3. ASSUMPTIONOF THE RISK: Participant understands that the Activities include work that may be hazardous to the Participant, including, but not limited to, demolition, tree removal, loading and unloading, use of herbicides and pesticides, use of hand tools, and use of power tools. Participant hereby expressly and specifically assumes the risk of injury or harm in the Activities and releases the Town from all liability for injury, illness, death, or property damage resulting from the Activities, this Includes, and is not limited to, claims arising under worker’s compensation and occupational disease laws. 4. INSURANCE: Participant understands that, except as otherwise agreed by the Town Council of the Town in writing, the Town does not carry or maintain health, medical, or disability insurance coverage for any Participant. Each Participant is expected and encouraged to obtain his or her own medical or health insurance coverage. 5. INDEMNITY and HOLD HARMLESS: As a Participant in this Program, Participant further agrees to indemnify and hold harmless and defend the Town and its officers, agents, servants, and employees from any and all claims resulting from injuries, including death, damages, and Losses sustained by the participation in, arising out of, connected with, or in any way associated with the Activities. 6. OTHER: Participant expressly agrees that this Waiver and Release is intended to be as broad and inclusive as permitted by the laws of the State of Indiana, and that this Release shall be governed and interpreted in accordance with the laws of the State of Indiana. Participant agrees that in the event that any clause or provision of this Waiver and Release shall be held to be invalid by any court of competent jurisdiction, the invalidity of such clause or provision shall not otherwise affect the remaining provisions of this Waiver and Release, which shall continue to be enforceable.
I have read and fully understand the above Program details and I fully understand that "THIS IS A WAIVER AND RELEASE AGREEMENT". Participant Signature or Parent/Guardian if Under 18.
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Participant Name or Parent/Guardian if under 18
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Witness Signature
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Witness Name:
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Sign Up
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