Waiver of Liability and Hold Harmless Agreement - City of Richmond

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City of Richmond
Waiver of Liability and Hold Harmless Agreement
Volunteer Services for Love Your Block 2012-2013
1. In consideration for being selected to serve as a Volunteer for the City of Richmond for
the Love Your Block Initiative (hereinafter referred to as LYB) throughout the 2012- 2013 calendar year,
I hereby RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE the City of Richmond,
Virginia, their officers, servants, agents, or employees, (hereinafter referred to as City) from or related to
any and all liability, claims, demands, actions, and causes whatsoever arising out of or related to any loss,
damage or injury, including death, that may be sustained by me or to any property belonging to me, or
otherwise, while participating in such LYB, or while in, on or upon any premises where the LYB is being
conducted.
2. I am fully aware of the risks and hazards connected with LYB, and I hereby elect to
voluntarily participate in said LYB project, and to engage in such LYB project knowing that the LYB
project may be hazardous to me and my property. I VOLUNTARILY ASSUME FULL
RESPONSIBILITY FOR ANY RISK OF LOSS, PROPERTY DAMAGE OR PERSONAL INJURY,
INCLUDING DEATH, that may be sustained by me, as a result of being engaged in such LYB project.
3. INDEMNIFICATION. I further hereby AGREE TO INDEMNIFY AND HOLD
HARMLESS the CITY from any loss, liability, damage or costs, including court cost and attorney’s
fees that the CITY may incur due to my participation in said LYB project.
4. It is my express intent that this Agreement shall bind the members of my family and
spouse, if I am alive, and my heirs, assigns and personal representative, if I am deceased or incapacitated,
and shall be deemed as a RELEASE, WAIVER, DISCHARGE AND COVENANT NOT TO SUE the
CITY. I hereby further agree that this Waiver of Liability and Hold Harmless Agreement shall be
construed in accordance with the laws of the State of Virginia.
5. I further grant to City of Richmond, its designees and successors, my consent to use my
name, photograph, likeness, image, voice and biography in any publications, advertising and publicity, in
connection with my participation with Love Your Block.
IN SIGNING THIS RELEASE, I ACKNOWLEDGE AND REPRESENT THAT I have read the
foregoing Waiver of Liability and Hold Harmless Agreement, understand it and sign it voluntarily as my
own free act and deed; no oral representations, statements or inducements, apart from the foregoing
written agreement, have been made; I am at least eighteen (18) years of age and fully competent; and I
execute this Release for full, adequate and complete consideration fully intending to be bound by the
same.
IN WITNESS WHEREOF, I have hereunto set my hand on this day of , 2012.

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City of Richmond
Waiver of Liability and Hold Harmless Agreement
Volunteer Services for Love Your Block 2012-2013
WITNESS: Volunteer:
Project Location: Project Date:
Name: Birth Date:
Signature: __________________________________________
Parent/guardian (if necessary): Relationship:
Parent/guardian Signature (if necessary):___________________________________
_____
Address: City: _______ State: _____
Parent Email: ____________
Parent Phone (if underage): ______