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2. Minor's First Name*
3. Minor's Last Name*
5. Parent/Guardian's First Name*
6. Parent/Guardian's Last Name*
8. Parent/Guardian's Phone Number*
9. Group Name*

   Name of individual that signed up online. 

   N/A if not with a group

11. Thank you for participating in this exciting opportunity in the City of Hemet. By completing this form, you agree to release the City of Hemet and organizations participating in the City of Hemet's Adopt-A-Street of all liability while serving as a participant. This Release and Waiver of Liability (the "Release") executed on this (DATE)

13. Date of Signing *
    Date of Signing

    Date of Signing

15. Release and Waiver: The minor (Participant) and their parent/guardian does hereby release and forever discharge and hold harmless the City of Hemet and it successors and assigns from any and all liability, claims, and demands of whatever kind or nature, either in law or in equity, which arise or may hereafter arise from Participant’s Activities with the City of Hemet. The participant understands that this Release discharges the City of Hemet from any liability or claim that the Participant may have against the City of Hemet with respect to any bodily injury, personal injury, illness, death, or property damage that may result from the Participant’s Activities with the City of Hemet, whether caused by the negligence of the City of Hemet or its officers, or assigns except for the sole negligence of the City of Hemet. Participant also understands that the City of Hemet does not assume any responsibility for or obligation to provide financial assistance or other assistance, including but not limited to medical, health, or disability insurance in the event of injury or illness. 

    Medical Treatment: Participant does hereby release and forever discharge the City of Hemet from any claim whatsoever which arises or may hereafter arise on account of any first aid, treatment, or service rendered in connection with the Participant’s Activities. 

    Assumption of the Risk: The Participant hereby expressly and specifically assumes the risk of injury or harm in the Activities and releases the City of Hemet from all liability for injury, illness, death, or property damage resulting from the Activities. 

    Insurance: The Participant understands that the City of Hemet does not carry or maintain health, medical, or disability insurance for any Participant. 

    Photographic Release: Participant does hereby grant and convey unto the City of Hemet all rights, title, and interest in any and all photographic images and video or audio recordings made by the City of Hemet during the Participant's Activities, including, but not limited to, any royalties, proceeds, or other benefits derived from such photographs or recordings. 

    Other: Participant expressly agrees that this Release is intended to be as broad and inclusive as permitted by the laws of the State of California and that this Release shall be governed by and interpreted in accordance with the laws of the State of California. Participant agrees that in the event that any clause or provision of this Release shall be held to be invalid by any court of competent jurisdiction, the invalidity of such clause or provision shall not otherwise affect the remaining provisions of this Release which shall continue to be enforceable.  

    As the parent/guardian of the minor child's name under the age of 18, I hereby give permission for him/her to participate in one or more City of Hemet's Adopt-A-Street Program. By my signature, I release the City of Hemet, its officials, staff, or agents from any liability or responsibility for any injuries or damages he/she may cause or suffer as a result of participation in the Adopt-A-Street Program.

17. Safety Training Statement*

    1. I have watched the safety training video.
18. Safety Training Video
    Safety Training Video
20. Agreement*

    1. I, the parent or guardian of the minor listed above, have read and agree to the terms and conditions outlined in the waiver agreement.
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22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

* indicates a required field