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Krazy for the Kazoo Registration Form

Registrant

T-shirt size:

Glove size:

If you are affiliated with a group, what is the group name?

Other Members/Family

T-shirt size:

Glove size:

T-shirt size:

Glove size:

T-shirt size:

Glove size:

T-shirt size:

Glove size:

Names of Minor/s

T-shirt size:

Glove size:

T-shirt size:

Glove size:

T-shirt size:

Glove size:

T-shirt size:

Glove size:

Please check the boxes of ALL tasks you are interested in helping with: (check all that apply)
Trash pick-up Use of loppers, pruners, hedge trimmers Use of bow-saw

Please check site conditions you are willing to work in: (check all that apply)

Easy: relatively flat

Medium: slight changes in elevation, shrub & tree obstructions

In water: use of waders/ankle to chest-high water navigation

Please list anything else we should be made aware of:

RELEASE OF CLAIMS WAIVER FORM

I fully understand that by signing this liability disclaimer, I, on behalf of myself and my agents, my group members, heirs and next of kin, assume all risks and hazards incidental to my participation in this activity, including transportation to and from these activities. I do hereby waive, release, absolve, indemnify, and agree to hold harmless, collectively, and individually, the City of Battle Creek, and Calhoun County from any claim arising from sickness, injury or death to me or my property except if caused by their gross negligence or willful and wanton misconduct.

I agree that if the City of Battle Creek, and Calhoun County are sued by anyone else because of claimed conduct of myself, I will indemnify the City of Battle Creek, the City of Springfield, and Calhoun County for all damages and costs, including attorney’s fees.

Yes, you may use my name and picture(s) taken during the event in any promotional avenues for the City of Battle Creek, Calhoun County and/or partnering organizations

No, you may not use my name and picture(s) taken during the event in any promotional avenues for the City of Battle Creek, Calhoun County and/or partnering organizations

IN CASE OF EMERGENCY PLEASE CONTACT:

Name:

Phone:

I HAVE READ AND UNDERSTAND THE AGREEMENT:

Date:

Leave this empty:

Your legal name

Your email address

Please Confirm full name and signature.

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Timestamp

Audit

August 12, 2021 8:43 pm EST

Krazy for the Kazoo Registration Form Uploaded by Bessie Ploeg - beploeg@battlecreekmi.gov IP 23.28.246.223

August 13, 2021 2:31 pm EST

Document owner denise@greenstreetmkg.com has handed over this document to beploeg@battlecreekmi.gov 2021-08-13 14:31:30 - 69.47.18.147