• Plogging in Prospect Park Participation Waiver And Release Form

  • DOB
     - -
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.
  • In consideration for permitting me to participate in volunteer activities ("the Program"), I hereby agree as follows:

    1. I acknowledge and understand that, during the Program, I will be engaging in activities, including, but not limited to, running, trash pickup, and other land-based activities. I understand that there are risks associated with these activities, including but not limited to: potential exposure to infectious diseases; water hazards; contact with animals, unstable terrain, and potentially hazardous materials such as broken glass, condoms, or syringes; and the effects of weather, including heat, humidity, cold and/or precipitation. Further, there may be other risks not known or not reasonably foreseeable at this time.

    2. I acknowledge and understand that I will be participating in the Program voluntarily, and that such participation involves risk of damage to personal property or serious injury, including but not limited to death, which may result from my own actions, inactions, or negligence; the actions, inactions, or negligence of others; or the condition of the premises or of any equipment used. Further, there may be other risks not known or not reasonably foreseeable at this time.

    3. I agree that I will take full responsibility for myself and my safety during the Program and assume all risk of injury from any of the above dangers or any other danger, including but not limited to responsibility for all expenses, medical, or otherwise, following any damages, injury, or death.

    4. I have no medical conditions that would affect my ability to participate in the Program. I understand that I must be aware of my surroundings at all times during the Program and will follow any instructions issued by Lily Fang, and wear and/or use any safety equipment provided to me. I consent to emergency medical treatment in the event of injury or illness while participating in the Program.

    5. I release, waive, and discharge Lily Fang ("Releasee") from any and all liability to me, my heirs and next of kin, or any other person, for any and all claims, demands, losses, or damage, including death or damage to property, which, in whole or in part, arise from, relate to, or are alleged to arise from or relate to, the Program or for the facilities or equipment used by me or by others, or are caused or alleged to be caused, in whole or in part, by the negligence of the Releasee or otherwise to the fullest extent of the law, and I covenant not to sue the Releasee with respect thereto.

    6. I hereby consent to the publication and use of my name and/or likeness ("Likeness") by the Releasee to promote, publicize. and advertise the Program. Likeness means, but is not be limited to, photographs, sound and/or video recordings, films, or any other tangible work in any media (including but not limited to social media) or format, now known or hereafter discovered, as well as copies of any of these. I agree that all material prepared with the Likeness will be the property of the Releasee and that I shall not have any right of review or approval of the use of the Likeness, or any right to compensation for such use. I also hereby release the Releasee from any and all claims, demands, and liabilities in connection with the uses set forth in this Section 6.

    This waiver may not be modified in any way. If any part of this waiver is determined to be invalid by law, all other parts of this waiver shall remain valid and enforceable.

    I HAVE READ THIS WAIVER AND RELEASE, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT VOLUNTARILY.

  • Today's Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: