2014 Mad River RiverSweep Cleanup

Release Form

I, the undersigned, for the duration of the event, agree to follow these instructions:

·  To always follow the directions & instructions of the event coordinators & staff.

·  To wear & use the equipment provided for the event.

·  To never work alone.

·  To be careful when handling dangerous or sharp objects such as broken glass or aerosol canisters.

·  To report incidents/accidents to my group leader when they happen.

·  To be aware of any medical or physical limitations I may have & to only do what I am able to do.

·  To watch for dangerous/nuisance plants & animals; snakes, wasps, poison ivy & so on.

·  To ask permission before entering private property & to identify myself as a river cleanup volunteer (this does not authorize you to trespass).

I also understand that the nature of the cleanup is dangerous and carries high risks of harm, and voluntarily accept these risks. I hereby release and forever discharge all members of the 2014 Mad River RiverSweep Cleanup: The Environmental Enforcement Alliance, Division of Watercraft, Springfield Township, Moorefield Township, German Township, Mad River Township, Mad River Adventures Canoe Livery, City of Springfield Zoning and Code Enforcement, City of Springfield Police Division, Clark County Combined Health District, Clark County Park District, Clark County Engineers Office, Clark County Sheriff’s Office, Clark County Waste Management District, City of Springfield Prosecutor’s Office, US Army Corp of Engineers-C.J. Brown Dam and Reservoir, Rivers Unlimited, National Trails Parks and Recreation, and Clark County Soil and Water Conservation District and their employees, representatives, officers, agents, coordinators, and volunteers from any and all liability for personal injury or property damage of any kind sustained in any manner from my participation in the Mad River Cleanup. I agree to indemnify and hold harmless the sponsors and their representatives from any and all claims, liability, loss and expense, including but not limited to damages, legal expenses and costs of defense, in any manner arising from my participation in the 2014 Mad River RiverSweep Cleanup event.

Permission to use your photograph in future promotions and publications?

[ ] YES [ ] NO

Participant’s Name: ______

Address:______

City, State, Zip Code:______

Telephone/E-mail:______

Participant’s Signature: ______Date:______

OR

Signature of Parent or Guardian (if under 18 years):______Date:______

Complete and send release form to:

E-Mail:

Fax: (937) 390-5625

Form may also be taken to event sign-in table on June 14, 2014.