HPLB WAIVER OF RESPONSIBILITY

HARVEST PARTNERS LB of CITYHEART! 

harvestpartnerslb@ourcityheart.org

WAIVER OF RESPONSIBILITY

for participation in Harvest Partners LB activities

I acknowledge that participation in collecting and transporting produce as part of the Harvest Partners mission may involve risk of bodily injury, property damage or other types of danger:

I fully assume the risks involved as acceptable to me and agree to use my best judgment in undertaking these activities and follow all safety instructions. If minors are present for whom I am responsible, I further agree to assume the risks involved on their behalf, and to personally ensure that the children participate safely.

I RELEASE, WAIVE, AND DISCHARGE AND COVENANT NOT TO SUE: Harvest Partners LB of CityHeART, INC, the participating homeowner, any individual assisting these organizations or persons, including volunteers, from all liability to me, my personal representatives, heirs, and next of kin, for all loss or damage and any claims or demands therefore, including attorney fees, on  account of injury to myself or my property, whether caused by the negligence of Harvest Partners LB, its agents, director, managers, volunteers or otherwise, which  I may experience or sustain arising directly or indirectly out of my aforementioned participation, and INDEMNIFY, DEFEND, AND HOLD HARMLESS: Harvest Partners LB of CityHeART, INC, the participating homeowner, any individual assisting these organizations or persons, including volunteers, participants, spectators, FROM ANY AND ALL CLAIMS and COSTS arising directly or indirectly out of my activities, acts, and/or omissions involving Harvest Partners LB of CityHeART, INC.

Photo Release: I give my permission to Harvest Partners LB of CityHeART, INC to reproduce any photographs or video taken during the project in which I am or am pictured.  (Please print NO PHOTOS below to opt out)

I AM A COMPETENT ADULT AND HAVE CAREFULLY READ AND UNDERSTAND COMPLETELY AND CLEARLY THE ABOVE PROVISIONS AND VOLUNTARILY SIGN THIS WAIVER AND INDEMNIFICATION FORM

Participant Signature: ______________________________________

Date: __________________

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