Each volunteer must complete this form in able to participate in the Adopt-A-Median Program.
I have read this form (the “Waiver and Release Form”) carefully and am aware that, by signing this form and participating in the City of Madison’s Adopt-A-Median Program (the “Program”), I am Waiving and Releasing all claims arising out of such participation and agreeing to abide by the Program rules set forth herein. In consideration of the City accepting me as a volunteer participating in the Program, I hereby agree as follows:
I have fully informed myself of all of the details of the Program and have received satisfactory answers to all questions I have concerning the Program and the risks inherent in the Program and believe and represent that I have the necessary abilities, skills and knowledge to participate in the Program. I recognize and acknowledge that the Program involves risks, including but not limited to bodily injury, death, and property loss. I hereby agree to, and do, assume the full risks of any injuries, including death, and of any property loss, and of all expenses, costs, damages and losses that I, or the person on whose behalf I am signing, may sustain as a result of participating in any and all activities connected with or associated with the Program.
I also understand I am solely and fully responsible for my actions. Furthermore, while engaged in such activities I will make safety my primary concern and at all times use and implement proper procedures and precautionary measures.
I understand that my involvement in this activity is entirely voluntary and I freely choose to participate. I agree to conduct myself in a safe and appropriate manner, at all times. I acknowledge that the City of Madison does not provide any kind of medical coverage for me, should I be injured or killed as a result of participation in this Program.
I HEREBY AGREE TO, AND DO, WAIVE, RELEASE AND RELINQUISH ALL CLAIMS, DEMANDS, RIGHTS OF ACTION, DAMAGES, LIABILITIES AND CONTROVERSIES OF EVERY KIND, KNOWN AND UNKNOWN, PRESENT AND FUTURE, THAT I, OR THE PERSON ON WHOSE BEHALF I AM SIGNING, MAY HAVE AGAINST THE CITY AND ITS OFFICERS, AGENTS, EMPLOYEES, AND OFFICIALS ARISING OUT OF, CONNECTED WITH, OR IN ANY WAY RELATED TO THE PROGRAM OR MY PARTICIPATION THEREIN.
While participating in this volunteer activity, the City of Madison will provide the same protection to authorized volunteers for claims arising from acts done within the scope of the volunteer’s responsibilities as is provided for City employees under its liability policy.
I agree to abide by the following rules and conditions of participation in the Program:
I have read and fully understand the above Waiver and Release Form and execute it of my own free will and without any reservation whatsoever.