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Acknowledgement of Risk & Release

Acknowledgement of Risk and Release

As a participant in the Storm Drain Stenciling activity sponsored by the City of Boulder Stormwater Quality Program, I recognize and acknowledge that there are certain risks of injury and I agree to assume the full risk of any injuries, property damage or loss which I may sustain as a result of participating in any activities and all activities connected with storm drain stenciling.

Further, I am aware that I will be performing this task in the right-of-way on the street. I agree to waive and relinquish all claims I may have as a result of participating in the Storm Drain Stenciling activity against the City of Boulder and its officers, agents, servants, and employees. I further agree to indemnify and hold harmless and defend the City of Boulder and its officers, servants and employees from any and all claims by other parties resulting from injuries, damages, and losses caused by me arising out of, connected with, or in any way associated with the Storm Drain Stenciling Activity.

In the event of any emergency, I authorize City officials to secure from any licensed hospital, physician, and/or medical personnel, any treatment deemed necessary for my immediate care and agree that I will be responsible for payment of any and all medical services rendered. I have read and fully understand the above activity details, I acknowledge and release all claims, give permission to secure treatment, and understand that this agreement shall not be modified orally.

Participant Name_________________________________________________
Address ______________________________________________
Phone ( ) _____________________________
Parent/Guardian Signature ________________________________
Date ________ 


INVITATION BASIN is a community project actively seeking public participation. We appreciate all feedback and welcome comments, suggestions and contributions. To find out more about how you can be involved, click here. Help BASIN serve your needs, take our "10 questions in 10 seconds" survey.

BASIN is supported by the US EPA, the City of Boulder, the Keep it Clean Partnership, BCWI and BCN

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Last Page Update - Tuesday December 27, 2005