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

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): ______

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2 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): ______

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Waiver of Liability and Hold Harmless Agreement - City of Richmond

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