Please print and sign the following waiver form before you
participate in a Highland Avenue clean up day sponsored
by Pierce Downer's Heritage Alliance.  Please then send your
completed waiver form to Jim Cavallo
, either by faxing it to
630-971-1505
or mailing it to him at 6912 Main Street,
Suite 123, Downers Grove, IL 60516
.

 

SECTION 3. VILLAGE AND COUNTY INDEMNIFICATION

      A.        To the fullest extent permitted by law, VOLUNTEER shall, and does
hereby agree to, defend, save, indemnify, and hold COUNTY and VILLAGE, its
corporate authorities, elected and appointed officials, officers, boards, commission,
legal counsel, insurers, employees, and agents, harmless from and against any injury,
claim, demand, suit, judgment, executing, liability, obligation, debt, damages, or
penalty (the "Claims") arising out of or resulting from, or alleged to arise out of or result
from, VOLUNTEER'S actions, negligence, or misconduct in connection with the
PROGRAM, except for the negligent act of the COUNTY or VILLAGE or their agents
or employees.

 

     B.       VOLUNTEER shall, and does hereby agree to pay all expenses incurred
by the COUNTY or VILLAGE in defending itself with regard to the above Claims,
including without limitation, all out-of-pocket expenses, attorney's fees, court costs, and
reasonable expenses of defending against any such Claims, including the reasonable
value of any services rendered by any employee of the COUNTY or VILLAGE.
I have read and fully understand the above WAIVER AND RELEASE OF ALL CLAIMS

and execute it of my own free will and without any reservation whatsoever on this date
___________________________,
20_____.

 

 

___________________________        ________________________________

Print Name of Participant                           Signature of Participant/Guardian-if Guardian,
                                                                       state your relationship to the Participant

 

 

___________________________        ________________________________

Print Name of Participant                           Signature of Participant/Guardian-if Guardian,
                                                                       state your relationship to the Participant

 

 

___________________________        ________________________________

Print Name of Participant                           Signature of Participant/Guardian-if Guardian,
                                                                       state your relationship to the Participant

 

___________________________        ________________________________

Print Name of Participant                           Signature of Participant/Guardian-if Guardian,
                                                                       state your relationship to the Participant


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