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ADOPT-A-HIGHWAY

INDIVIDUAL RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF THE RISK AND INDEMNITY AGREEMENT AND CONSENT TO MEDICAL TREATMENT

In consideration of being allowed to occupy the Minnehaha County right-of-way or participate in the adopt-a-highway program, I understand and acknowledge as follows:

1.  I am aware of, appreciate the character of the many dangers associated with picking up litter on a highway right-of-way and risks and hazards posed by traffic, nature, the condition of the right-of-way and hazardous materials that may be found on the right of way and voluntarily assume any and all risks of injury, deathA, damage or loss, from each and every cause resulting from my occupation of the right-of-way or participation in the Adopt-a-Highway Program.

2.  Minnehaha County, its officers, employees, and agents will not incur liability to me, my heirs, successors, or assigns resulting from my occupation of the right-of-way, participation in the Adopt-a-Highway Program or other voluntary activities on or near the right-of-way. 

3.  The County makes no promises, guarantees, or warranties, nor is it obligated to me in any way due to my participation in this program.

4.  I hereby release and discharge the County from all claims, demands or causes of action of any kind or nature that may result from my participation in the Adopt-a-Highway Program or other voluntary activities on or near the right-of-way. 

5.  I agree to indemnify, defend, and hold harmless the County, its officers, employees and agents, from all liability for any damages or injuries resulting from any of my acts or failure to act during my participation in the Adopt-a-Highway Program or other voluntary activities on or near the right-of-way. 

6.  I consent to receive any medical treatment deemed advisable during my participation in the activity listed above.

I HAVE READ THIS RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF THE RISK AND INDEMNITY AGREEMENT AND CONSENT TO MEDICAL TREATMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I GIVE UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT VOLUNTARILY WITH NO INDUCEMENT, ASSURANCE, OR GUARANTEE BEING MADE TO ME, AND I INTEND MY SIGNATURE TO BE A COMPLETE AND UNCONDITIONAL RELASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.

 

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First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email
A signed copy of this waiver will be sent to the email address you provide.
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.
Parent or Guardian's Name

First Name*

Last Name*

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. 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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