Adopt-A-Highway Program

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KEEP NOBLESVILLE BEAUTIFUL WAIVER:

I hereby release, indemnify, and hold harmless the City of Noblesville, the Keep Noblesville Beautiful program and their respective officers, directors, employees, agents, contractors, subcontractors, representatives, successors and assigns, and all persons conducting directly or indirectly, the activities surrounding my involvement as a volunteer from any and all claims, rights, demands, action, cause of action, expenses and damages, which I or my heirs, personal representative, successors, assigns or anyone claiming by, through or under me ever had, now have, or may have against the parties identified above arising from any injury, act or omission relating in the way to my participation as a volunteer.

I understand that I am to receive no payment for services from the Keep Noblesville Beautiful program. I am not an employee. I will not be entitled to and will not receive Worker’s Compensations benefits or other similar payments from the City of Noblesville under the law of the State of Indiana in the event that I am injured.

I hereby consent that the City of Noblesville, in conjunction with the Keep Noblesville Beautiful program, to copyright, publish, use, sell or assign any and all photographic portraits or pictures, television spots, movie films, videotapes, and/or sound records or any part thereof, that they may take or make of me during my work as a volunteer in which I may be included in whole or in part, whether separate from or in conjunction with, illustrative or written manner, story or news item, motions pictures, television or radio spots, or for publicity, advertising or any other lawful purpose whatsoever, in conjunction with my name or in anonymity. I hereby waive any right I may have to inspect and/or approve the finished product or the advertising copy that may be used in connection therewith or the use to which it may be applied.

I hereby waive all claims for compensation of such use or for damages.

IN DEPT OF TRANSPORTATION WAIVER:

I hereby agree to waive any and all claims against the Indiana Department of Transportation arising in any fashion from my voluntary participation in the Adopt-a-Highway program. It is acknowledged that work on or near the highway right-of-way is inherently dangerous and that any and all risks associated with such work are voluntarily assumed.

I acknowledge that I have read, fully understand and am voluntarily signing this release without any inducement from any of the staff.

State Form 47471 (1-96)

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KNB Volunteer Waiver

KEEP NOBLESVILLE BEAUTIFUL WAIVER:

IN DEPT OF TRANSPORTATION WAIVER: