CIGARETTE LITTER AWARENESS DAY

Waiver of Liability (Must be signed by all that are going to participate or by the legal guardian if the participant is under 18.)

I, the undersigned, understand that Keep Pearland Beautiful, the City of Pearland, and all sponsors, officials, volunteers and persons connected with Keep Pearland Beautiful are to be released and hereby held harmless for any injuries or accidents which I may suffer while participating in the event or as a result thereof. In this connection, I hereby waive any claims for damages to any person or property for myself, my administrators, or my heirs and assignees. I hereby grant full permission for any publicity and/or promotion purposes without any obligations or liability to me. I have read and understand this release.

Name of Participant : ___________________________ Age of Participant _____yrs

________________________________  ______________

Signature of Participant if 18 yr or older                     DATE                

________________________________     ________________________________  ______________

Signature of Parent or Guardian if under 18 yr old      Printed Name of Parent or Guardian                             DATE

Name of Participant : ___________________________ Age of Participant _____yrs

________________________________  ______________

Signature of Participant if 18 yr or older                     DATE                

________________________________     ________________________________  ______________

Signature of Parent or Guardian if under 18 yr old      Printed Name of Parent or Guardian                             DATE

Name of Participant : ___________________________ Age of Participant _____yrs

________________________________  ______________

Signature of Participant if 18 yr or older                     DATE                

________________________________     ________________________________  ______________

Signature of Parent or Guardian if under 18 yr old      Printed Name of Parent or Guardian                             DATE