Agreement: I, hereby, understand and agree to the following:

PARTICIPATION, MAINTENANCE AND USE

·  This is a voluntary program and that I will not be provided with any compensation for my participation in this program;

·  I grant access to the participating property to BSA Rain Check representatives to determine if downspout(s) may be safely disconnected; install rain barrels, as practicable; and monitor performance of barrels. All field crews will be properly identified and attempt to communicate with the property owner prior to entering the property.At no time will a field crew personnel need to enter the structure(s) (Ex. Home) on the property.

·  Rain Barrels are property of the Buffalo Sewer Authority and must remain at the property they are installed;

·  I will maintain the barrel. This includes draining the barrel regularly, cleaning the screen and/filter, inspecting the barrel for any cracks or damage, winterizing the barrel according to provided instructions, and reconnecting the barrel each spring. Rain Check will provide educational materials, as well as email reminders, to support barrel maintenance.

·  BSA Rain Check is not responsible for replacement of lost or damaged rain barrels.

·  If for any reason, I cannot fulfill the maintenance requirements, or no longer have a need for the rain barrel, I must 1) direct the downspout runoff in accordance with City of Buffalo Building Code requirements; and 2) contact the BSA Rain Check program at (716) 851-4664 X. 4254 to make arrangements to return the barrel.

X______I agree

LIABILITY RELEASE

·  To the fullest extent permitted by law, I hereby release the Buffalo Sewer Authority and City of Buffalo, and their respective officers, agents, representatives and employees from all liability and any damages that may result from my participation in the downspout disconnection/rain barrel program.

X______I agree

PHOTO RELEASE

·  I hereby grant Rain Check and its partnering entities the right to use the photographs, videos and/or voice recordings. These records become the property of Rain Check or its representatives.

·  The records may be used for promotional or publicity purposes and may be published in mass media publications. They may appear in connection with (a) the Rain Check website, www.raincheck.ngrok.io; (b) publications for advertising, marketing, information and education, or any other publication Rain Check may deem useful and appropriate, or (c) any electronic and print media (i.e. television, social media, CD-ROM, video, pamphlets, mailings, etc.).

·  You hereby release Rain Check from claims and expenses arising from the use of your materials as herein specified.

·  This release is given without promise of compensation.

·  This release is effective until terminated by a retraction in writing from the person granting this authorization, or an immediate family member. Such revocation shall only be effective to prevent any expanded future use of the records.

X______I agree (Optional)

Address: ______

Name (Printed): ______

Phone Number:______E-mail:______

Signature: ______Date: ______

Rain Barrel Color Preference (Green, Tan, Grey, Black): ______

Select only one: Do you need to be present during (Install) (Inspection) (Neither)?

Is there anything else we need to be aware of? Such as __Locked Gate __Dog __Other

______

Rain Check Buffalo

1038 City Hall

Buffalo, NY 14202-3378

T: 716-851-4664 x 4254

E: