Create a Website Account - Manage notification subscriptions, save form progress and more.
I, _________________________,(guardian’s signature if participant is a minor), freely, voluntarily, and without duress execute this Waiver and Release under the following terms:
The City of Superior Environmental Services Division Adopt-a-Storm Drain Program is an educational opportunity and I agree to participate knowing that there are inherent risks with any storm drain maintenance activity. I expressly and specifically assume the risk of injury or harm in the activities and release the City of Superior from all liability for injury, illness, death, or property damage resulting from those activities. Unless caused by the intentional or reckless conduct by the city.
I do hereby release and forever discharge and hold the City of Superior harmless from any and all liability, claims and demands, either in law or in equity, which arise or may hereafter arise from my activities with the City of Superior. Unless caused by the intentional or reckless conduct by the city.
I do hereby release and forever discharge the City of Superior from any claims whatsoever which arise or may hereafter arise on account of any first aid treatment, or service rendered in connection with my activities with the City of Superior.
I understand that the City of Superior does not carry or maintain health, medical, or disability insurance for any Adopt-a-Storm Drain Volunteer. Each Participant is expected and encouraged to obtain his or her own medical or health insurance coverage.
The Adopt-a-Storm Drain Participant does hereby grant and convey unto the City of Superior all right, title, and interest in any and all photographic images and video or audio recordings made by the City of Superior during the participant’s activities with the City of Superior, including, but not limited to, any royalties, proceeds, or other benefits derived from such photographs or recordings.
I expressly agree that this Waiver and Release is intended to be as broad and inclusive as permitted by the laws of the State of Wisconsin, and that this Waiver and Release shall be governed by and interpreted in accordance with the laws of the State of Wisconsin. I agree that if any clause or provision of this Waiver and Release shall be held to be invalid by any court of competent jurisdiction, the invalidity of such clause or provision shall not otherwise affect the remaining provisions of this Waiver and Release which shall continue to be enforceable. Participant has had the opportunity to negotiate the terms of this release.
I have read this Waiver and Release of Liability thoroughly and fully understand and enter into it on behalf of myself, my heirs, next of kin, assigns, and personal representatives. No one has made any representations, statements, or inducements that change or modify anything written in this Waiver and Release of Liability.
This field is not part of the form submission.
* indicates a required field