Signature of Participant. Address. City

Transcripción

1 FRIENDS OF THE LA RIVER LOS ANGELES RIVER CLEANUP PARTICIPANT RELEASE OF LIABILITY, INDEMNIFICATION, & IMAGE RELEASE FORM As a Participant I freely choose to participate in the Friends of the Los Angeles River s ( FOLAR ) Los Angeles River CleanUp and I understand and agree to the following: 1. That my participation in the Cleanup is strictly as a volunteer, and I am not entitled to any compensation or benefit from FOLAR and/or any of the Cleanup sponsors; 2. That while FOLAR may provide me with safety suggestions ( Suggestions ), such Suggestions are in no way comprehensive of any and all possible risks that may arise from my participation in the CleanUp nor are the Suggestions guaranteed methods for preventing injury. I am solely responsible for my safety and wellbeing during my participation in the CleanUp and will take safety precautions to the best of my ability; 3. That participation in the CleanUp will require some physical effort (i.e.: bending, lifting, walking, kneeling) and may involve the use of equipment or tools, to be provided by FOLAR; that participation involves risks and hazards, some of which are predictable in nature but some of which may be unanticipated; and that participation may involve stepping into water or on slippery or muddy surfaces. Knowing all this, I choose to participate in the CleanUp. I knowingly and voluntarily assume all risks of accident, damage and/or loss to my person or property as a result of my participation in the CleanUp; 4. That in consideration of FOLAR allowing my volunteer participation in the CleanUp, I hereby release and forever discharge FOLAR, all CleanUp sponsors, any permitting or participating government entities or agencies, any other participating volunteer organizations and FOLAR s officers, directors, agents, volunteers, representatives, independent contractors and/or employees ( Released Parties ) from any and all actions, demands, damages, expenses, attorney fees and claims and/or counterclaims of any kind or nature, whether known or unknown, including but not limited to any claims of negligence, arising out of or in any way connected with my participation in the CleanUp which I, or my heirs, executors, administrators or assigns, may have or might in the future have against Released Parties; 5. That also in consideration for my participation in the CleanUp, I hereby agree to indemnify and hold harmless the Released Parties from any and all actions, demands, damages, expenses, attorney fees and claims and/or counterclaims of any kind or nature, whether known or unknown, including but not limited to any claims of negligence, arising out of or in any way connected with my participation in the CleanUp that any person had, now has, may have or might in the future have against the Released Parties and; 6. That, furthermore, in consideration for my participation in the CleanUp, I grant and convey to FOLAR and its representatives, licensees and assignees, all of my right, title and interests in any and all photographs, images, videos or audio recordings of me or my likeness or voice made, by FOLAR, a FOLAR volunteer, local media agencies or an observer of the CleanUp, in connection with my participation in the CleanUp. I have read this entire participant, release of liability, indemnification and image release Form, I understand and accept its terms and conditions, and I voluntarily sign this form. Participant Name (print) Signature of Participant Date Phone Number Address Address City State Zip Code If participant is under 18 years of age, the following parental release must be signed by participant s parent or legal guardian in addition to the above form. As the parent and/or guardian of I have read this Participant, Release of Liability, Indemnification and Image Release Form and agree to its terms, and I hereby release and forever discharge the FOLAR Released Parties under the terms stated above of any claim which I might have against the FOLAR Released Parties, both in my own behalf and as legal representative of Participant. I further agree to indemnify and hold the FOLAR Released Parties harmless from any and all actions, demands, damages, expenses, attorney fees and claims and/or counterclaims of any kind or nature, whether known or unknown, including but not limited to any claims of negligence, arising out of or in any way connected with Participant s participation in the CleanUp. Parent and/or guardian name (print) Signature of parent and/or guardian Date FRIENDS OF THE LOS ANGELES RIVER WEST AVE 26 SUITE 250, LOS ANGELES, CA 90065

2 FRIENDS OF THE LA RIVER LOS ANGELES RIVER CLEANUP FORMULARIO DE EXENCIÓN DE RESPONSABILIDAD, INDEMNIZACIÓN Y CESIÓN DE IMÁGENES Como participante, decido libremente participar en Friends of the Los Angeles River s («FOLAR») Los Angeles River CleanUp. Asimismo, entiendo y estoy de acuerdo con lo siguiente: 1. que mi participación en CleanUp es estrictamente como voluntario, y que no tengo derecho a ninguna compensación o beneficio por parte de FOLAR o cualquiera de los patrocinadores de Cleanup; 2. que si bien FOLAR puede ofrecerme sugerencias de seguridad ( «Sugerencias»), dichas sugerencias no tienen en cuenta de ninguna manera todos los posibles riesgos que puedan derivarse de mi participación en CleanUp, ni las sugerencias son métodos garantizados para la prevención de lesiones. Soy el único responsable de mi seguridad y bienestar durante mi participación en CleanUp y tomaré las medidas de seguridad a mi mejor saber; 3. que la participación en CleanUp requerirá algo de esfuerzo físico (es decir: agacharse, hacer levantamientos, caminar, arrodillarse) y que puede implicar el uso de equipos o herramientas que serán proporcionados por FOLAR; que la participación implica riesgos y peligros, algunos de los cuales son predecibles, mientras que otros pueden ser imprevistos; y que la participación puede implicar entrar en el agua o en superficies resbaladizas o lodosas. A sabiendas de todo lo anterior, decido participar en CleanUp. Asumo a sabiendas y voluntariamente todos los riesgos de accidente, daño o pérdida de mi persona o propiedad como resultado de mi participación en CleanUp; 4. que en consideración de que FOLAR permite mi participación voluntaria en CleanUp, eximo por la presente y para siempre a FOLAR, a todos los patrocinadores de CleanUp, a cualquier entidad o agencia gubernamental participante o autorizante, a otras organizaciones participantes voluntarias, así como a los funcionarios, directores, agentes, voluntarios, representantes, participantes, contratistas independientes o empleados («Partes Liberadas») de cualquier acción, demanda, daño, gasto, honorario de abogados y reclamación o reconvención de cualquier tipo o naturaleza, ya sean conocido o desconocido, que incluyen pero no se limitan a cualquier reclamación de negligencia, derivada o relacionada de alguna manera con mi participación en CleanUp que yo, o mis herederos, ejecutores, administradores o cesionarios, pueda(n) tener o pudiera(n) tener en el futuro contra las Partes Liberadas; 5. que en relación con mi participación en CleanUp, acepto por la presente indemnizar y mantener indemne a las Partes Liberadas de cualquier acción, demanda, daño, gasto, honorario de abogados y reclamación o reconvención de cualquier tipo o naturaleza, ya sean conocido o desconocido, que incluyen pero no se limitan a cualquier reclamación de negligencia, derivada o relacionada de alguna manera con mi participación en CleanUp que cualquier persona haya tenido, tiene o pueda o pudiera tener en el futuro contra las Partes Liberadas y; 6. que, asimismo, en relación con mi participación en CleanUp, otorgo y transfiero a FOLAR y a sus representantes, licenciatarios y cesionarios todos mis derechos, títulos e intereses en todas las fotografías, imágenes, vídeos o grabaciones de audio de mi persona o mi imagen, o de mi voz, tomados por FOLAR, un voluntario de FOLAR, agencias de medios locales o un observador de CleanUp relacionados con mi participación en CleanUp. He leído al completo este formulario de exención de responsabilidad, indemnización y cesión de imágenes; entiendo y acepto los términos y las condiciones, y firmo oluntariamente este formulario. Nombre del participante (impresión) Firma del participante Fecha Número de teléfono Dirección de correo electrónico Domicilio Ciudad Estado Código postal Si el participante es menor de 18 años, un progenitor o tutor legal del participante debe firmar el siguiente consentimiento paterno, además del anterior formulario. Como progenitor o tutor de He leído y acepto los términos de este formulario de exención de responsabilidad, indemnización y cesión de imagen, y por la presente exonero y libero para siempre a las Partes Liberadas de FOLAR, en virtud de los términos indicados anteriormente, de cualquier reclamación que yo pueda tener en contra de las Partes Liberadas de FOLAR, tanto en mi propio nombre y como representante legal del participante. Asimismo, acepto compensar y liberar de toda responsabilidad a las Partes Liberadas de FOLAR de cualquier acción, demanda, daño, gasto, honorario de abogados y reclamación o reconvención de cualquier tipo o naturaleza, conocidos o desconocidos, que incluyen pero no se limitan a cualquier reclamación de negligencia, derivada o relacionada de alguna manera con la participación del participante en CleanUp. Nombre del progenitor o tutor (impresión) Firma del padre o tutor Fecha FRIENDS OF THE LOS ANGELES RIVER WEST AVE 26 SUITE 250, LOS ANGELES, CA 90065

3 Letter of Indemnification Permit No. PCFA I,, agree to release, indemnify, defend, and hold harmless the County of Los Angeles and its Special Districts, the Los Angeles County Flood Control District, and their elected and appointed officials, officers, employees, and agents from and against any and all liability costs or expenses, including defense costs and legal fees, arising from or connected with any claims and/or lawsuits which may arise or result from any work and/or use of and access to the property of the County of Los Angeles permitted by the above referenced permit number. i, acknowledge that I will perform the work authorized under this permit. (Signature) (Date) C:\Documenls and Settngs\BPARK.PWDOMAIN\Desktop\Letter of Indemnification.doc

4 LOS ANGELES COUNTY DEPARTMENT OF PUBLIC WORKS Letter of Indemnification Permit No. PCFA I,, representing (Parent / Legal Guardian) (Child / Minor) agree to release, indemnify, defend, and hold harmless the County of Los Angeles and its Special Districts, the Los Angeles County Flood Control District, and their elected and appointed officials, officers, employees, and agents from and against any and all liability costs or expenses, including defense costs and legal fees, arising from or connected with any claims and/or lawsuits which may arise or result from any work and/or use of and access to the property of the County of Los Angeles permitted by the above referenced permit number. (Signature) (Date) O:\PROGRAMS\Section\Permits\Flood\Letter of Indemnification (3).doc

5 CITY OF GLENDALE COMMUNITY SERVICES & PARKS DEPARTMENT 2018 THE GREAT LA RIVER CLEAN-UP PARTICIPANT S: RELEASE OF LIABILITY & INDEMNITY AGREEMENT I,, acknowledge that I have voluntarily applied with the City of Glendale s Community Services & Parks Department ( the City ) to participate in La Gran Limpieza ( The Great Clean-Up ) within and along the Los Angeles River. The event, held by the Friends of the Los Angeles River, takes place on Saturday, April 14, 2018 from 8 a.m. to noon. Activities include, but are not limited to: picking up litter and debris, broom sweeping, weed pulling, or vegetation raking. I understand and agree that the clean-up activities take place outdoors within and along the Los Angeles River, which has wet and uneven natural surfaces. Working in those areas has risks, including (but not limited to) the risk of: tripping; falling; water ingestion; drowning; hypothermia (chill leading to a lowered body temperature); colliding with objects or people; fatigue or exhaustion; dehydration; cold or hot weather conditions; insect or animal bites; poisonous plants; sunburn; cuts or scrapes; pain or soreness; broken bones; or death. I also understand and agree that while I participate in The Great Clean-Up event, I will be under adult supervision of a member from the City s Community Services & Parks Department. I represent that I am: (1) in good physical condition and emotional health, (2) not suffering from any condition, disease, or disability that can hinder or endanger my participation in The Great Clean-Up activities, and (3) qualified to participate in The Great Clean-Up activities. PLEASE INITIAL:. I UNDERSTAND THAT RIVER CLEAN-UP ACTIVITIES ARE PHYSICALLY DEMANDING, CAN BE DANGEROUS, AND HAVE A RISK OF INJURY OR DEATH. I AM FULLY AWARE THAT I AM VOLUNTARILY PARTICIPATING IN THESE ACTIVITIES WITH MY KNOWLEDGE OF THE INHERENT RISKS AND HAZARDS INVOLVED. I HEREBY AGREE TO ACCEPT ALL RISKS OF INJURY, DEATH, OR PROPERTY DAMAGE. PLEASE INITIAL:. AS LAWFUL CONSIDERATION for the City s permitting me to participate in The Great Clean-Up activities, I HEREBY AGREE that I, my heirs, distributees, guardians, legal representatives, and assigns WILL NOT MAKE A CLAIM AGAINST, SUE, OR PROSECUTE the City, its officers, agents, or employees for injury, death, or damage arising out of the negligence, intentional, or other acts, howsoever caused, by the City or by any officer, agent, or employee of the City, as a result of my participation in The Great Clean-Up activities. In addition, I HEREBY RELEASE, DISCHARGE, AND AGREE TO INDEMNIFY (TO COMPENSATE AND TO DEFEND) the City, its officers, agents, and employees from and against ALL ACTIONS, CLAIMS, OR DEMANDS that I, my heirs, distributees, guardians, legal representatives, or assigns now have, or may later have from today, for injury, death, or damage arising out of my participation in The Great Clean-Up activities. I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT TO INDEMNIFY BETWEEN MYSELF AND THE CITY, AND I SIGN IT OF MY OWN FREE WILL. By my signature below, I certify that I am eighteen (18) years of age or older. I am under the age of eighteen (18) years. My parent/guardian has read this form with me and has completed the Parent s/guardian s Release of Liability & Indemnity Agreement on the reverse side. Dated Participant s Signature Home Address City, State, Zip Code Home Telephone Number Staff Initials Business Telephone Number (REV. 4/14) J:\FILES\DOCFILES\VARIOUS\INDEMNITY\THE GREAT LA RIVER CLEAN-UP MGV.doc

6 CITY OF GLENDALE COMMUNITY SERVICES & PARKS DEPARTMENT 2018 THE GREAT LA RIVER CLEAN-UP PARENT S / GUARDIAN S: RELEASE OF LIABILITY & INDEMNITY AGREEMENT I,, the parent/guardian of, acknowledge that my child has voluntarily applied with the City of Glendale s Community Services & Parks Department ( the City ) to participate in La Gran Limpieza ( The Great Clean-Up ) within and along the Los Angeles River. The event, held by the Friends of the Los Angeles River, takes place on Saturday, April 14, 2018 from 8:00 a.m. to noon. Activities include, but are not limited to: picking up litter and debris, broom sweeping, weed pulling, or vegetation raking. I understand and agree that my child s clean-up activities take place outdoors within and along the Los Angeles River, which has wet and uneven natural surfaces. Working in those areas has risks, including (but not limited to) the risk of: tripping; falling; water ingestion; drowning; hypothermia (chill leading to a lowered body temperature); colliding with objects or people; fatigue or exhaustion; dehydration; cold or hot weather conditions; insect or animal bites; poisonous plants; sunburn; cuts or scrapes; pain or soreness; broken bones; or death. I also understand and agree that while my child participates in The Great Clean-Up event, my child will be under adult supervision of a member from the City s Community Services & Parks Department. I represent that my child is: (1) in good physical condition and emotional health, (2) not suffering from any condition, disease, or disability that can hinder or endanger my child s participation in The Great Clean-Up activities, and (3) qualified to participate in The Great Clean-Up activities. PLEASE INITIAL:. I UNDERSTAND THAT RIVER CLEAN-UP ACTIVITIES ARE PHYSICALLY DEMANDING, CAN BE DANGEROUS, AND HAVE A RISK OF INJURY OR DEATH. I AM FULLY AWARE THAT MY CHILD IS VOLUNTARILY PARTICIPATING IN THESE ACTIVITIES WITH MY KNOWLEDGE OF THE INHERENT RISKS AND HAZARDS INVOLVED. I HEREBY AGREE TO ACCEPT ON MY CHILD S BEHALF ANY AND ALL RISKS OF INJURY, DEATH, OR PROPERTY DAMAGE. PLEASE INITIAL:. AS LAWFUL CONSIDERATION for the City s permitting my child to participate in The Great Clean-Up activities, I HEREBY AGREE that I, my child, our heirs, distributees, guardians, legal representatives, and assigns WILL NOT MAKE A CLAIM AGAINST, SUE, OR PROSECUTE the City, its officers, agents, or employees for injury, death, or damage arising out of the negligence, intentional, or other acts, howsoever caused, by the City or by any officer, agent, or employee of the City, as a result of my child s participation in The Great Clean-Up activities. In addition, I HEREBY RELEASE, DISCHARGE, AND AGREE TO INDEMNIFY (TO COMPENSATE AND TO DEFEND) the City, its officers, agents, and employees from and against ALL ACTIONS, CLAIMS, OR DEMANDS that I, my child, our heirs, distributees, guardians, legal representatives, or assigns now have, or may later have from today, for injury, death, or damage arising out of my child s participation in The Great Clean-Up activities. I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT TO INDEMNIFY BETWEEN MYSELF (AND ON MY CHILD S BEHALF) AND THE CITY, AND I SIGN IT OF MY OWN FREE WILL.. Dated Signature of Parent or Guardian Home Address City, State, Zip Code Home Telephone Number Staff Initials Business Telephone Number (REV. 4/14) J:\FILES\DOCFILES\VARIOUS\INDEMNITY\THE GREAT LA RIVER CLEAN-UP MGV.doc