Please Complete the Entry Form for the Neighborhood Litter Stomp 2011 event

NEIGHBORHOOD LITTER STOMP
GROUP REGISTRATION FORM
  To register for the Neighborhood Litter Stomp 2011 event, fill out the online registration form below.  
  Release Form  
 
  Cleanup Date: September 17, 2011  
  Participant Name:  
  Neighborhood Association  
  Mailing Address:  
  City:  
  Zip:  
  Phone Number:  
  Email Address:  
  T-Shirt Size and Quantities:  
 
YOUTH MED SMALL MEDIUM LARGE X-LARGE 2XL
  
  Cleanup Location:  
  Comments or Questions:  
  Release Form: Volunteer Release of Liabiltiy, Hold Harmless and Indemnification Agreement  
    In consideration of the opportunity to engage in volunteer work during the Neighborhood Litter Stomp, the undersigned, my heirs and assigns, hereby waive all claims for injuries, damages or losses to my person or property which may be caused directly or indirectly, by any act, omission or negligence of the Neighborhood Litter Stomp and/or the City of Fort Worth (“City”), their officers, agents and employees, in the execution of the volunteer work. The undersigned, my heirs and assigns, hereby covenant and agree to indemnify and hold harmless the Neighborhood Litter Stomp and the City, their officers, agents and employees, from any and all costs, charges, claims, demands, losses, damages, causes of action, suits and liabilities of any kind, including the expenses of litigation, court costs and attorney’s fees, for injuries to, or the death or illness of any person, or for damage to any property, arising out of or in connection with my involvement in the volunteer work, regardless of whether such injuries, illness, death or damages are reasonably foreseeable or reasonably with the contemplation of the parties to this agreement. The undersigned, my heirs and assigns, hereby further covenant and agree not to sue the Neighborhood Litter Stomp and the City, their officers, agents, and employees for any matter which arises from the execution of the volunteer work.  
  Initial Waiver: I have read, understood, and accept the agreement above. My submission form shall act as my legal signature.  
      Initials of: registrant if over 18 years of age; or parent/legal guardian of minor, incapacitated, or mentally challenge person.