1 Kiwanis Aurora, Kiwanis International, City of Aurora, Aurora
Kiwanis Aurora, Kiwanis International, City of Aurora, Aurora Township, Fox Valley Park District & Fox Metro Water Reclamation District Intergovernmental and Combined Liability Waiver Form: WAIVER AND RELEASE OF ALL CLAIMS AND ASSUMPTION OF RISK Participant’s Name: (print) _______________________________________________ Address: ______________________________ City: _______________________________ State: _____________ Zip: __________ Telephone: ( ______ ) ___________________ Email: _________________________
WARNING Participation in the 2016 Kiwanis One Day Fox River Clean Up Project may involve hazardous activities such as water contact activities where lifeguards are not provided and clean-up work on, in, or adjacent to a waterway or stream not owned, supervised, maintained, or controlled by the local government entities or charitable organizations sponsoring this project.
On behalf of myself, and/or my minor child or ward, my/our successors, executors, administrators and/or assigns, including any one claiming by or on behalf of me/us, in consideration of the right to participate in the 2016 Kiwanis One Day Fox River Clean Up Project and to use the facilities and equipment of the sponsoring entities and organizations, subject to the terms and conditions of this agreement, I agree as follows: 1. I recognize and acknowledge that there are certain risks of physical injury to participants in water contact and stream or waterway clean up activities, and I voluntarily agree to assume the full risk of and legal responsibility for any and all injuries, damages or loss, regardless of severity, including personal injury or death, and property damage that I or my minor child or ward may sustain as a result of said participation. 2. I do hereby fully waive, release, agree to indemnify, hold harmless and forever discharge Kiwanis Aurora, Kiwanis International, City of Aurora, Aurora Township, Fox Valley Park District and Fox Metro Water Reclamation District, including their officers, agents, insurers, employees, and volunteers, from and against any and all claims, demands, and causes of action for injuries, damages, or loss of every nature arising out of my participation in the 2016 Kiwanis One Day Fox River Clean Up Project that I or my minor child or ward, or anyone claiming on my or our behalf, may have against the aforesaid sponsoring entities and organizations. 1
3. I execute this Waiver and Release of All Claims Agreement freely and voluntarily and for and on behalf of myself and/or my minor child and/or ward, and for anyone claiming under or through any of them, and for each of my or our or their respective heirs, administrators, executors, successors, representatives and assigns. If any provision of this Agreement is found to be invalid or illegal by a court of competent jurisdiction, I agree that the remaining provisions shall be construed as if the affected provision had not been included in order to effectuate the intent of the parties.
BEFORE SIGNING THIS FORM, I ACKNOWLEDGE THAT I HAVE READ AND FULLY UNDERSTAND ALL OF THE INFORMATION IN IT. I ACKNOWLEDGE THAT I DO NOT NEED ANY FURTHER EXPLANATION OF ITS CONTENTS AND WAIVE ANY FURTHER EXPLANATION. I HAVE VOLUNTARILY AGREED TO ITS TERMS AND PROVISIONS AND I AGREE THAT NO OTHER STATEMENT, REPRESENTATION OR INDUCEMENT APART FROM WHAT IS STATED IN THIS AGREEMENT HAVE BEEN MADE TO ME TO OBTAIN MY CONSENT AND MY SIGNATURE TO IT. THIS IS A BINDING LEGAL AGREEMENT.
Dated: _______________________, 2016. Participant’s Signature: ________________________________________________ IF A PARTICIPANT IS UNDER THE AGE OF 18 YEARS, THE SIGNATURE OF A PARENT OR LEGAL GUARDIAN IS ALSO REQUIRED. Minor Child or Ward’s Name: ____________________________________________ Minor Child or Ward’s Date of Birth: ____________________________ __________ Dated: _______________________, 2016. Parent or Legal Guardian’s Signature: _________________________________________________
2
Kiwanis Club of Aurora Announces Fox River Cleanup “One Day” Service Project April 2, 2016 8:00 am – 12:00pm The “One-Day” objective is to unite volunteers to participate on the same day in a hands-on service project to better our community. At the last cleanup event in 2015, there were over 325 volunteers who helped in removing trash from in and around the Indian Creek area. The goal for the Fox River this year is to have 300 volunteers come together and impact our community. Kiwanis is partnering with Fox Metro Water Reclamation District, City of Aurora, Aurora Township, Fox Valley Park District, and other local agencies in conducting what we hope will be another successful cleanup event. Volunteers are required to sign a liability waiver; youth under 18 must have a parent or guardian signed waiver. Adolescent groups are required to provide 1 adult supervisor for every 10 children. A 2.5 mile portion of the Fox River from Ashland Avenue to the Fox Valley Park District’s Cole Center will be the target area this year. Headquarters will be at the Cole Center located at 101 W. Illinois Ave. After check-in, breakfast snacks will be available. Transportation to and from the various river segments will be provided. An appreciation lunch will conclude the event back at headquarters. Please bring proper attire and dress for changing weather conditions. Please contact Pat Divine at (630) 301-6817 regarding the cleanup. You may also e-mail your questions to [email protected]
Additional notes: Fox Metro will be present at the “One Day” cleanup event collecting expired and unwanted medications. The mission of Fox Metro is to prevent improperly disposed of medications from entering our water ways. Medications will be turned over to the Illinois Environmental Protection Agency for proper disposal. Use this opportunity as one more way to protect our environment.
WARNING Participation in the 2016 Kiwanis One Day Fox River Clean Up Project may involve hazardous activities such as water contact activities where lifeguards are not provided and clean-up work on, in, or adjacent to a waterway or stream not owned, supervised, maintained, or controlled by the local government entities or charitable organizations sponsoring this project.
On behalf of myself, and/or my minor child or ward, my/our successors, executors, administrators and/or assigns, including any one claiming by or on behalf of me/us, in consideration of the right to participate in the 2016 Kiwanis One Day Fox River Clean Up Project and to use the facilities and equipment of the sponsoring entities and organizations, subject to the terms and conditions of this agreement, I agree as follows: 1. I recognize and acknowledge that there are certain risks of physical injury to participants in water contact and stream or waterway clean up activities, and I voluntarily agree to assume the full risk of and legal responsibility for any and all injuries, damages or loss, regardless of severity, including personal injury or death, and property damage that I or my minor child or ward may sustain as a result of said participation. 2. I do hereby fully waive, release, agree to indemnify, hold harmless and forever discharge Kiwanis Aurora, Kiwanis International, City of Aurora, Aurora Township, Fox Valley Park District and Fox Metro Water Reclamation District, including their officers, agents, insurers, employees, and volunteers, from and against any and all claims, demands, and causes of action for injuries, damages, or loss of every nature arising out of my participation in the 2016 Kiwanis One Day Fox River Clean Up Project that I or my minor child or ward, or anyone claiming on my or our behalf, may have against the aforesaid sponsoring entities and organizations. 1
3. I execute this Waiver and Release of All Claims Agreement freely and voluntarily and for and on behalf of myself and/or my minor child and/or ward, and for anyone claiming under or through any of them, and for each of my or our or their respective heirs, administrators, executors, successors, representatives and assigns. If any provision of this Agreement is found to be invalid or illegal by a court of competent jurisdiction, I agree that the remaining provisions shall be construed as if the affected provision had not been included in order to effectuate the intent of the parties.
BEFORE SIGNING THIS FORM, I ACKNOWLEDGE THAT I HAVE READ AND FULLY UNDERSTAND ALL OF THE INFORMATION IN IT. I ACKNOWLEDGE THAT I DO NOT NEED ANY FURTHER EXPLANATION OF ITS CONTENTS AND WAIVE ANY FURTHER EXPLANATION. I HAVE VOLUNTARILY AGREED TO ITS TERMS AND PROVISIONS AND I AGREE THAT NO OTHER STATEMENT, REPRESENTATION OR INDUCEMENT APART FROM WHAT IS STATED IN THIS AGREEMENT HAVE BEEN MADE TO ME TO OBTAIN MY CONSENT AND MY SIGNATURE TO IT. THIS IS A BINDING LEGAL AGREEMENT.
Dated: _______________________, 2016. Participant’s Signature: ________________________________________________ IF A PARTICIPANT IS UNDER THE AGE OF 18 YEARS, THE SIGNATURE OF A PARENT OR LEGAL GUARDIAN IS ALSO REQUIRED. Minor Child or Ward’s Name: ____________________________________________ Minor Child or Ward’s Date of Birth: ____________________________ __________ Dated: _______________________, 2016. Parent or Legal Guardian’s Signature: _________________________________________________
2
Kiwanis Club of Aurora Announces Fox River Cleanup “One Day” Service Project April 2, 2016 8:00 am – 12:00pm The “One-Day” objective is to unite volunteers to participate on the same day in a hands-on service project to better our community. At the last cleanup event in 2015, there were over 325 volunteers who helped in removing trash from in and around the Indian Creek area. The goal for the Fox River this year is to have 300 volunteers come together and impact our community. Kiwanis is partnering with Fox Metro Water Reclamation District, City of Aurora, Aurora Township, Fox Valley Park District, and other local agencies in conducting what we hope will be another successful cleanup event. Volunteers are required to sign a liability waiver; youth under 18 must have a parent or guardian signed waiver. Adolescent groups are required to provide 1 adult supervisor for every 10 children. A 2.5 mile portion of the Fox River from Ashland Avenue to the Fox Valley Park District’s Cole Center will be the target area this year. Headquarters will be at the Cole Center located at 101 W. Illinois Ave. After check-in, breakfast snacks will be available. Transportation to and from the various river segments will be provided. An appreciation lunch will conclude the event back at headquarters. Please bring proper attire and dress for changing weather conditions. Please contact Pat Divine at (630) 301-6817 regarding the cleanup. You may also e-mail your questions to [email protected]
Additional notes: Fox Metro will be present at the “One Day” cleanup event collecting expired and unwanted medications. The mission of Fox Metro is to prevent improperly disposed of medications from entering our water ways. Medications will be turned over to the Illinois Environmental Protection Agency for proper disposal. Use this opportunity as one more way to protect our environment.
