Thank you for making
a difference!

Print this form if you have more people to sign up. Bring all completed forms when you pick up supplies on Wednesday April 9th.

Liability Waiver

First name

Last name

Date of Birth

Emergency Contact Name

Emergency Contact

Are you physically able to participate in this potentially strenuous activity?

Yes

Please specify anything we should know about

Initials

Media Release for participants and Minors, I hereby grant permission to the City of Santa Fe/Keep Santa Fe Beautiful to use photographs and/or videos of me or my child taken during a Keep Santa Fe Beautiful sponsored event. Photos and videos may be used for publications, news release, online, and in other communications related to the mission of the City of Santa Fe/Keep Santa Fe Beautiful

In consideration of the opportunity to engage in volunteer work through the City of Santa Fe I, 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 arising from or related to the activities of the City of Santa Fe. I, the undersigned, understand that by participating in this volunteer activity I will be exposed to the risks of accident and injury and that I will follow the City of Santa Fe safety requirements and instructions. I hereby release and hold harmless the City of Santa Fe and their officers, agents, and employees from any and all claims, including bodily injury, death or property damage which may occur due to my or my child’s participation in these volunteer activities. I, the undersigned, my heirs and assigns, hereby covenant and agree to indemnify and hold harmless the City of Santa Fe, 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 activities. I, the undersigned, my heirs and assigns, hereby further covenant the City of Santa Fe, their officers, agents, and employees for any matter which arises from the execution of the volunteer work.

I accept terms & conditions

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!

Thank you for making a difference!

Liability Waiver

Thank you for making
a difference!