I certify that I am the owner of the property at which I am requesting a tree and that my property sustained damage from a recent event. I permit Keep Terrebonne Beautiful, a Keep America Beautiful Affiliate, and its representatives, partners, and volunteers to enter my property for the limited purpose of participating in RETREET programming. Such participation may include, but is not limited to, surveying the property to locate suitable planting sites, delivering supplies, digging holes, and planting trees. Indemnification: I indemnify and hold harmless Keep Terrebonne Beautiful, its representatives, partners, and volunteers from any liability for damage, injury, or loss to my property resulting from activities associated with RETREET programming.
I agree to allow agents of Louisiana 811 to enter my property to mark utility lines, ensuring the safety of the volunteers and the proper placement of the tree. I understand that Keep Terrebonne Beautiful will submit a utility locate request on my behalf.
I understand that a representative of Keep Terrebonne Beautiful or one of its chosen partners will work with me to determine the best planting location for my tree(s), and that the selected area (s) is/are not to be changed once decided upon and marked, unless safety dictates otherwise as determined by Keep Terrebonne Beautiful.
I promise to water and care for my tree after it is planted, as instructed by Keep Terrebonne Beautiful.
I hereby grant to Keep Terrebonne Beautiful its partners and employees, agents and affiliates, and its directors, officers, shareholders, employees, and their respective licensees, successors, and assignees (herein collectively called “the licensed parties”) the right and permission to use, at any time and from time to time, my photograph(s) or likeness, or any part thereof, in any form and any statements made by me, either alone or accompanied by other material for educational and publicity purposes in connection with Keep Terrebonne Beautiful.
Permission is granted for use in any medium now known or hereafter developed, including printed media, video, still photography, and the Internet. I hereby release and discharge the licensed parties from any claim or liability (including, without limitation, defamation or invasion of privacy) based upon any such use or alteration, blurring, distortion, optical illusion, retouching or other use in a composite form, whether or not intentional, or based upon any other circumstance in the production, dissemination or use of my likeness or photograph for any part thereof with or without such aforesaid material, for such purposes.