The Rest Of Your Party
Please provide names (first and last) for up to four (4) people you are bringing with you to help with the Round Up.
Liability Waiver(Required) PLEASE READ CAREFULLY AND SIGN: I, INDIVIDUALLY, AND AS THE REGISTRANT FOR ALL PERSONS ON MY TEAM UNDERSTAND THAT THE CITY OF MADEIRA BEACH (COMB) OR ANY DEPARTMENT/ORGANIZATION/FIRM ASSOCIATED WITH THE CITY OF MADEIRA BEACH SHALL NOT BE LIABLE UNDER ANY CIRCUMSTANCES FOR ANY INJURIES OR DAMAGES TO PERSON(S), BE THEY PHYSICAL INJURIES OR OTHERWISE. LIKEWISE, INJURIES OR DAMAGES TO PROPERTY, ARISING OUT OF, RESULTING FROM OR IN ANY WAY CONNECTED WITH MY TEAM’S PARTICIPATION IN THE MAD BEACH AMPHIBIOUS TRASH ROUND UP WHETHER CAUSED BY OR CONTRIBUTED TO BY ANY NEGLIGENT ACT OR NEGLIGENT OMISSION OF THE COMB OR BY ANY OTHER REASON OR CAUSE WHATSOEVER. IN CONSIDERATION OF THE ACCEPTANCE OF ME, MY TEAM AND FOR OTHER GOOD REPRESENTATIVES, SUCCESSORS, ASSIGNS, THE PARENT ORGANIZATION/FIRM OR ANY FIRM/ORGANIZATION THAT THE COMB IS PART OF OR A DIVISION OF, ITS/THEIR DIRECTORS, OFFICERS, EMPLOYEES AND AGENTS ARE ABSOLVED OF AND FROM ALL CLAIMS, SUITS, OBLIGATIONS, LIABILITIES, LOSSES, DAMAGES, COSTS OR EXPENSES WHICH OUR MASTER, CREW, OWNER(S), OPERATOR(S), TEAM OR GUESTS ABOARD OR THEIR HEIRS, EXECUTORS, ADMINISTRATORS, LEGAL REPRESENTATIVES SUCCESSORS AND/OR ASSIGNS MAY HAVE AGAINST COMB ARISING OUT OF, RESULTING FROM, OR IN ANY WAY CONNECTED WITH MY/OUR PARTICIPATION IN THE MAD BEACH AMPHIBIOUS TRASH ROUND UP. WE UNDERSTAND THAT THIS RELEASE INCLUDES ANY CLAIMS BASED UPON ANY NEGLIGENT ACT OR NEGLIGENT OMISSIONS OF THE COMB. TO THE FULLEST EXTENT PERMITTED BY LAW, INDIVIDUALLY AND AS THE REGISTRANT FOR ALL PERSONS ON MY TEAM HEREBY AGREE TO INDEMNIFY, TO DEFEND WITH COUNSEL ACCEPTABLE TO THE COMB AND TO HOLD THE COMB AND ITS HEIRS, EXECUTORS, ADMINISTRATORS, LEGAL REPRESENTATIVES, SUCCESSORS, ASSIGNS, PARENT FIRM/ORGANIZATION OR ANY FIRM/ORGANIZATION THAT THE COMB IS PART OF OR A DIVISION OF, ITS/THEIR DIRECTORS, OFFICERS, EMPLOYEES AND AGENTS HARMLESS FROM AND AGAINST ANY AND ALL CLAIMS, SUITS, OBLIGATIONS, LIABILITIES, LOSSES, DAMAGES, COSTS OR EXPENSES INCLUDING BUT NOT LIMITED TO REASONABLE ATTORNEY FEES SUFFERED BY THE COMB BY ANY OTHER PERSON OR PERSONS WHATSOEVER (INCLUDING ANYONE FOR WHOSE ACTS THE COMB MAY BE LIABLE), REGARDLESS OF WHETHER IT IS CAUSED BY OR IN PARTY WITH A PARTY, INDEMNIFIES AND HELD HARMLESS HEREUNDER, ARISING OUT OF, RESULTING FROM , OR IN ANYWAY CONNECTED WITH MY/OUR PARTICIPATION IN THE MAD BEACH AMPHIBIOUS TRASH ROUND UP.
THE CITY OF MADEIRA BEACH, ITS PRINCIPALS, AND ITS AFFILIATES ARE RELEASED FROM ALL LIABILITY AND DAMAGES WHATSOEVER WHICH MAY OCCUR BY VIRTUE OF PARTICIPATING IN SAID MAD BEACH AMPHIBIOUS TRASH ROUND UP. I FURTHER UNDERSTAND THAT THE DECISION TO PARTICIPATE IN THE MAD BEACH AMPHIBIOUS TRASH ROUND UP IS THE SOLE RESPONSIBILITY OF ME (THE INDIVIDUAL REGISTRANT) IN CONSIDERATION OF THE CITY OF MADEIRA BEACH ACCEPTING THIS REGISTRATION, THE REGISTRANT HEREBY AUTHORIZES THE CITY OF MADEIRA BEACH TO USE THE REGISTRANT’S NAME AND/OR LIKENESS, AS WELL AS THAT OF ALL MEMBERS IN HIS/HER PARTY, FREE OF CONSIDERATION, FOR PROMOTION AND ADVERTISING PURPOSES IN ANY MEDIA FORM AND REPRODUCTION, INCLUDING BUT NOT LIMITED TO, RADIO, TELEVISION, NEWSPAPER, BROCHURE AND VIDEO. THIS AGREEMENT SHALL TAKE EFFECT AS AN INSTRUMENT UNDER SEAL AND BE BINDING UPON AND INURE TO THE BENEFIT OF ME INDIVIDUALLY , MY TEAM, AS WELL AS THEIR HEIRS, EXECUTORS, ADMINISTRATORS, SUCCESSORS AND ASSIGNS OF EACH.