Liability Waiver

Keep Toledo/Lucas County Beautiful, Inc.

Liability Waiver

Including Assumption of Risks and Agreement of Release and Indemnification

This form must be read, understood, and signed by all Keep Toledo/Lucas County Beautiful Inc. (KT/LCB) Volunteers, adults and minors (persons under the age of 18) and by a parent or guardian (referred to as Parent) for a minor Volunteer. No volunteer may participate in any KT/LCB sponsored Volunteer activities unless these signatures are provided.

Description of Activities: Volunteer activities may include, but are not limited to litter cleanups (including cleanups along waterways and roads/streets), event/parade/festival help, recycling support, and office work. I understand that there may be possible exposure to traffic, deep and swiftly moving water, weeds, debris, sharp objects, and other potentially dangerous items. I also understand that many volunteer activities may expose individuals to manual labor, standing for long periods of time, and exposure to the sun, wind, rain, and other environmental hazards. When needed, Volunteers must wear safety vests, gloves, and sturdy shoes. If a safety orientation is necessary, Volunteers are required to be in attendance. Volunteers may be required to demonstrate required skills taught during the safety orientation, and be able to understand all instruction and risks prior to Volunteering.

Medical Concerns: In most cases volunteer activities can be adjusted to accommodate most all participants. Participants with underlying medical problems that put them at greater risk of injury or illness during an activity must carefully consider those risks before choosing to participate, and if they proceed, they do so at their own risk. KT/LCB reserves the right to exclude any Volunteer from participation, for medical, safety, or other reasons. Participants may notify KT/LCB Staff of a request for accessibility accommodations. Such requests will be considered and may be granted if reasonable and if the accommodation does not in any way compromise safety of any participants or staff.

Inherent and Other Risks: Physical risks would typically range from small scrapes, cuts, bruises, and falls to bites and stings. The risk of more serious injury would be unlikely, but certainly exists. Injuries may be a natural consequence of the volunteer activity being undertaken, as a result of environmental hazards (including terrain and weather), a result of errors in judgment or other negligence of the staff, volunteer, or other individuals. Injuries may occur in spite of the reasonable efforts of the staff to prevent them. In all cases, these inherent risks, and other risks which may not be inherent, whether or not described above must be accepted by those who choose to volunteer.

In consideration of the activity(ies) which I and my family have agreed to participate in, I (we) agree to the following:

I understand the nature of the activities that I will engage in. I understand there are risks of injury associated with these activities. I acknowledge and voluntarily assume the risks associated with these activities, inherent and otherwise, and whether or not described above, including those which may result from the negligent acts or omissions of other volunteers or staff.

I hereby release, indemnify, and hold harmless KT/LCB, its owners, agents, and employees and the owner or owners of the property on which the volunteer activity is conducted. I agree not to sue them for any liability for causes of action, claims and demands of any kind and nature whatsoever that may arise out of or relate in any way to my or my minor child’s participation in volunteer activities.

I accept responsibility for any expenses that may be incurred for any illness or injury that may result from my, or my minor child’s participation in a volunteer opportunity.

In some circumstances a vehicle (either provided for you/or your own) may be used in conjunction with a volunteer project. You understand that KT/LCB will be held harmless of any damage that could occur as well as liability during the project.
Prescreening Health Survey - to be conducted prior to registration and repeated 24 hours prior to event

People with COVID-19 have had a wide range of symptoms reported – from mild symptoms to severe illness.

Symptoms may appear two to 14 days after exposure to the virus.
In an effort to keep you, our volunteers, and community as safe as possible, please review the indicator symptoms below identifying if you have experienced any of the following within the past 14 days.

☐ Cough
☐ Shortness of breath or difficulty breathing
☐ Fever
☐ Chills
☐ Repeated shaking with chills
☐ Muscle pain
☐ Headache
☐ Sore throat
☐ New loss of taste or smell

If you have a cough and shortness of breath, difficulty breathing, or two of any the other symptoms in this list above, these symptoms indicate you may have been exposed to, and may test positive for COVID-19. In exercising an abundance of caution, do not volunteer for our event. Continue to monitor your health conditions closely and seek medical attention if necessary.

Please let us know if you will not be able to volunteer at this time so we can update our volunteer registration list.
I agree to report any change in my health status as it relates to the CDC published COVID-19 symptoms (cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sorethroat, or new loss of taste/smell) for a period of 14 days before and after my volunteer event. It is understood and I grant permission to the event organizer to make a reasonable effort to notify others I may have come into contact while volunteering so they can self-isolate themselves and monitor their own health status. It is understood that event organizers will NOT disclose my personal identity or reported health information.
By filling in my name below I agree that I have read, fully understand, and hereby agree to the terms of this agreement, voluntarily and with knowledge of the potential risks. I acknowledge that this agreement shall be effective and binding upon me, my heirs, assigns, personal representative, and estates.
Additionally, at this event I understand that Social Distancing and PPE recommendations, as outlined by Keep Americal Beautiful, will be followed. By filling in my name below I acknowledge that you have reviewed these recommendations (by clicking here) and agreed to follow them.
Print Name of Volunteer*

First NameLast Name
Date*

MonthDayYear
Date
E-mail*
Phone Number*

Area CodePhone Number
For what volunteer opportunity are you filling out this wavier?

Toledo Litter LeagueRamp It UpAdopt-a-RoadOther
Ramp it Up participants must watch the safety video at https://youtu.be/qwTaEDNNFLA*

I have watched the safety video and agree to follow all safety instructions.
What is your Litter League Team?*
Signature*

Clear
If this wavier is for a minor (under the age of 18).

I am the parent or guardian of the minor child whose name appears on this release form. I have discussed the terms of the above Agreement with my child and am assured by my child that he or she understands the agreement and has freely accepted its terms. I give my child permission to participate in volunteer opportunities.
Name of Parent/Legal Guardian if Volunteer is a Minor

First NameLast Name
Date

MonthDayYear
Date

MEDIA CONSENT, RELEASE, AND WAIVER

I hereby give consent to Keep Toledo/Lucas County Beautiful (KTLCB) to photograph, videotape, or otherwise digitally record and use images and/or sound recordings of myself or my child or children (if applicable) to use in any public media, including radio, television, internet, social media, print or in any of the organization’s or its partners’ publications, productions, or posts. I understand that the intended use of such images and information is solely for the purpose of advertising, marketing, fundraising and/or the promotional and public awareness purposes for the organization. I hereby waive any rights or interest in the images or recordings, as contemplated in this release.

I acknowledge that this consent to use images and/or recordings is being made solely for the benefit of the organization and comes without any expectation of monetary compensation or other benefit to me. To the extent that any benefit accrues or might accrue to the organization from the use of images or information, I hereby and forever waive any interest in or claim to such benefits.

I hereby release and forever discharge the organization (including without limitation all corporate affiliates and officers, directors, trustees, donors, employees, agents and volunteers) from any and all claims, liability, actions, suits, demands, costs, expenses or indebtedness arising out of, related to, or in any way connected with the use of images and materials described herein, and I hereby waive all rights and interest in and to such information and materials.

I further acknowledge that there is no guarantee that any or all of the participants’ images or recordings will be used in any released media.

I have been informed that this authorization is voluntary and is subject to revocation at any time, except to the extent that action has been taken in reliance thereon, by notifying the organization in writing at:
1011 Matzinger Rd.
Toledo OH, 43612
Name of Adult (Parent or Legal Guardian if applicable)*

First NameLast Name
Name of Child (if applicable)

First NameLast Name
I give consent to this media release.*

Yes - I give consentNo - I do not give consent
If Yes, please sign:

Clear
Date*

MonthDayYear
Date
Should be Empty:

If this wavier is for a minor (under the age of 18).