New Yorkshire Community Clean Up

Name: New Yorkshire Community Clean Up — Priority burlington
Start: 2019-06-22T09:00:00-0400
End: 2019-06-22T12:00:00-0400

Saturday, June 22, 2019
9:00 AM 12:00 PM 09:00 12:00

Burlington, New Jersey United States (map)

Google Calendar ICS

To participate, please complete the registration form below, as well as the Priority Burlington Clean Up Waiver.

If you would like to be contacted about future cleanup events, please provide the information below:

Name

First Name

Last Name

Address

An Individual

A Group

Group Registrants:

If registering as a group, please list names and ages of participants.

PRIORITY BURLINGTON CLEAN COMMUNITIES PROGRAM AGREEMENT TO ASSUME RISKS AND WAIVE AND RELEASE LIABILITY

I, the above-named Volunteer Participant, make the following statements: 1. My participation in this Project is voluntary. I will participate only in activities that are within my physical capacities. I understand that entry into, or cleanup of, any body of water is not part of the Project. 2. Assumption of Risk. I understand that my participation in the Project may result in injury to me or loss of personal property. The risks of my participation include, but are not limited to, reactions to or illnesses resulting from insect bites; cuts, abrasions, injuries from falls, infection from cuts and rash from exposure to poison ivy. I assume all of the risks associated with my participation in the Project. 3. Release. I release the above-named Sponsor(s), including its directors, officers, employees, representatives and agents, as well as all organizers and volunteers, from all actions or claims of any kind that relate to my participation in the Project. I understand and acknowledge that this waiver binds my heirs, administrators, executors, personal representatives, and assigns including, but not limited to, my spouse and children. 4. Hold Harmless. I agree to hold the Sponsor, including its directors, officers, employees, representatives and agents, as well as organizers and volunteers harmless and indemnify them against all actions or claims, including reasonable attorneys' fees, judgments and costs, with respect to any injuries, death, or other damages or loss that I may suffer as a result of my participation in the Project. 5. Medical Treatment. If I am injured during the Project, I agree and authorize the Sponsor, organizers or other volunteers of the Project to render medical or other services to me or request that others provide such services. I understand that by taking such action the Sponsor, organizers and volunteers are not admitting any liability to provide or to continue to provide any such services. I also understand that provision of such services does not constitute a waiver by the Sponsor, organizers or volunteers of any rights under this Agreement. I understand that if I require transport to a medical facility as a result of my participation in the Project, I am financially responsible for such transportation and medical treatment costs. If I am injured during the Project, it is my responsibility to seek appropriate medical care and to notify the Project Sponsor. 6. Photographs. I authorize the Sponsor to use any photographs or videos taken of me or my children during the Project for Project reporting and future promotional campaigns.

Date

Participant's Electronic Signature

If participant is under 18, Parent's Signature

Emergency Contact Name

Emergency Phone Number