Earth Week Registration Form


Registrant

Check if you are a group leader
Glove size:

If you are affiliated with a group, what is the group name?

Other Members/Family

Glove size:
Glove size:
Glove size:
Glove size:

Names of Minor/s

Glove size:
Glove size:
Glove size:
Glove size:

How did you hear about this event? (Please check all that apply.)

If you selected other, please enter how you heard about the event:

Please check the boxes of ALL tasks you are interested in helping with: (check all that apply)

Please check site conditions you are willing to work in: (check all that apply)

Please list anything else we should be made aware of:

 

RELEASE OF CLAIMS WAIVER FORM

I fully understand that by signing this liability disclaimer, I, on behalf of myself and my agents, my group members, heirs and next of kin, assume all risks and hazards incidental to my participation in this activity, including transportation to and from these activities. I do hereby waive, release, absolve, indemnify, and agree to hold harmless, collectively, and individually, the City of Battle Creek, and Calhoun County from any claim arising from sickness, injury or death to me or my property except if caused by their gross negligence or willful and wanton misconduct.

I agree that if the City of Battle Creek, and Calhoun County are sued by anyone else because of claimed conduct of myself, I will indemnify the City of Battle Creek, the City of Springfield, and Calhoun County for all damages and costs, including attorney’s fees.

IN CASE OF EMERGENCY PLEASE CONTACT:

Name:

Phone:

I HAVE READ AND UNDERSTAND THE AGREEMENT:

Date:

Leave this empty:

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Signature Certificate
Document name: Earth Week Registration Form
lock iconUnique Document ID: 1803423bc4227d32faf1cea767132e2351120907
Timestamp Audit
April 22, 2024 12:36 pm EDTEarth Week Registration Form Uploaded by Bessie Ploeg - beploeg@battlecreekmi.gov IP 23.28.246.223
April 22, 2024 1:44 pm EDT Document owner denise@greenstreetmkg.com has handed over this document to beploeg@battlecreekmi.gov 2024-04-22 13:44:28 - 23.28.246.223
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