Adopt-A-Street Cleanup Date *

Adopt-A-Street Location *

First Name *

Last Name *

Date of Birth *

I, the undersigned, in consideration of the below, acknowledge and agree to the following: *

 1.VOLUNTARY PARTICIPATION

I am voluntarily participating in the above-described volunteer event/activity ("Activity") sponsored by the Council Bluffs Chamber of Commerce ("Chamber"). I understand that my participation is entirely voluntary and that I am free to withdraw at any time. I understand any and all risks associated with this Activity. 

 2. ASSUMPTION OF RISKI ACKNOWLEDGE AND ASSUME ALL RISKS associated with participation in this Activity, including, but not limited to: 

Physical injury or illness	Property damage or loss
Risks associated with weather conditions	Risks from interaction with other participants
Risks from tools, equipment, materials, or garbage/litter	Risks inherent to the Activity environment or location

I understand these risks may result in property damage or loss, illness, personal injury, or death. 

3. INDEMNIFICATIONI agree to INDEMNIFY AND HOLD HARMLESS the Chamber from any claims, damages, or expenses (including attorney fees) arising from my participation in this Activity or any actions I may take during the Activity. 

4. COMPLIANCE WITH SAFETY RULESI agree to follow all safety instructions and rules provided by the City or its representatives during the Activity 

5. MEDICAL AUTHORIZATIONI authorize the City and its representatives to seek emergency medical treatment for me if necessary. I understand that I am responsible for all medical expenses incurred. 

6.RELEASE AND WAIVER

I HEREBY RELEASE, WAIVE, AND DISCHARGE the Chamber, its officials, employees, agents, volunteers, and representatives from any and all claims, demands, actions, or causes of action arising out of or relating to my participation in this Activity, including but not limited to: 

Personal injury, illness, or death;

Property damage or loss;

Any claims based on negligence, premisesliability, or other legal theories.

I FURTHER AGREE that this Waiver and Release of Liability shall bind the members of my family, if I am alive, and my heirs, assigns, and/or personal representatives, if I am deceased, and shall be deemed as a RELEASE, WAIVER, DISCHARGE, AND COVENANT NOT TO SUE the Council Bluffs Chamber, its officers, employees, or agents. 

This release applies to all claims whether known or unknown, foreseen or unforeseen. 

(Please check box after reading) *

7. ACKNOWLEDGMENTS

☐I am 18 years of age or older and have the legal capacity to enter into this agreement.

☐I read this waiver and understand its contents.

☐I understand that this waiver affects my legal rights and may prevent me from recovering damages in the event of an injury and/or property loss.

☐I am signing this waiver voluntarily and without coercion.

☐I understand that the Chamber recommends appropriate clothing, footwear, and safety equipment for this Activity.

☐I understand and agree that for, and in consideration of, the permission given to me to participate in this event or activity by the Chamber, that my agreement to this legal document is required.

Consent Waiver *

Checking 'YES' below indicates that I (in representation of the aforementioned organization) hereby acknowledge and declare that I have read and understand the statement found under the Terms & Conditions on this page, below. Marking the box 'YES' represents my signature and indicates my complete understanding and acceptance of the above.

This waiver shall be governed by the laws of the State of Iowa.

This waiver shall be governed by the laws of the State of Iowa. If any provision of this waiver is deemed invalid or unenforceable, the remaining provisions shall remain in full force and effect.