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Citywide Clean-Up Event Waiver

City of Mission

Waiver and Release of Liability

NOTICE: THIS DOCUMENT IS A CONTRACT WITH LEGAL CONSEQUENCES. READ IT CAREFULLY BEFORE SIGNING.

I fully understand and realize that the Citywide Cleanup Event is a physical and outdoor activity, and that by participating in this cleanup event I subject myself to the risk of injury, including both minor injuries and serious injuries, and death. I hereby knowingly and voluntarily assume all risks associated with my participation in the Earth Day Cleanup Event in the City of Mission, KS.

I hereby waive, release and discharge for myself (and my heirs, executors, administrators, legal representatives, assignees and successors in interest— hereafter referred to collectively as my “successors”) any and all claims, rights, and causes of action which I have, or which may hereafter accrue to me, against the City of Mission (and its officers, City Council members, directors, guests, employees, agents, and any other entity acting for or on its behalf— hereafter referred to collectively as its “affiliated persons”) that relate to or arise from any injury or damages that I may sustain directly or indirectly related to or arising out of my participation in the Citywide Cleanup Event. I expressly understand and agree that I am hereby waiving and releasing all claims against the City of Mission and its affiliated persons, including, but not limited to, claims based on the City of Mission’s negligence or the negligence of any affiliated person. In the event of any aforementioned injury or loss, I agree to waive any claim against the City of Mission and any affiliated persons. I further agree to fully INDEMNIFY, DEFEND, AND HOLD the City of Mission and any affiliated persons free and harmless from and against any claim, cause of action, liability, judgment, cost and expense, including, but not limited to, attorney fees.

I agree that it is my sole responsibility to take proper steps to reduce the risk of injury to myself and others while participating in the Citywide Cleanup Event, including wearing protective equipment, observing appropriate standards of conduct, following all instructions of affiliated persons, and otherwise acting in a reasonable, appropriate and prudent manner.

I agree for myself and my successors that the above provisions are contractually binding and are not mere recitals. I further agree that participation of the Citywide Cleanup Event is a privilege and not a right, and that I have signed this agreement in consideration for being allowed to utilize such participate in Citywide Cleanup Event.

I acknowledge that I have read this Waiver and Release of Liability in full, and understand that it constitutes a waiver and release of potential future claims against the City of Mission.




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First Participant's Name

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First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

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Middle Name

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Second Participant's Date of Birth*
Second Participant's Signature*
Third Participant's Name

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Third Participant's Date of Birth*
Third Participant's Signature*
Fourth Participant's Name

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Fourth Participant's Date of Birth*
Fourth Participant's Signature*
Fifth Participant's Name

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Fifth Participant's Date of Birth*
Fifth Participant's Signature*
Sixth Participant's Name

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Sixth Participant's Date of Birth*
Sixth Participant's Signature*
Seventh Participant's Name

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Seventh Participant's Date of Birth*
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Eighth Participant's Name

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Eighth Participant's Date of Birth*
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Ninth Participant's Name

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Ninth Participant's Date of Birth*
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Tenth Participant's Name

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Tenth Participant's Date of Birth*
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Parent or Guardian's Email Address

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Emergency Contact

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Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

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Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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