Adopt-1-Street Application Northridge West Neighborhood Council
The Adopt-1-Street Program allows individuals, businesses, faith-based groups, non-profit organizations, schools and other entities to take ownership of and participate in enhancing the appearance of their community.
All you need to do is fill out the form below and a staff person will contact you within two (2) days to discuss the next streps required to complete the Adopt-1-Street process.
If you have any immediate questions, contact Beautification Chairman, Jorge Antonio Jimenez at (818) 791-8599 or
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Primary Contact Name: (Must be 18 years or older)
Address where you want your free trash grabber delivered, if needed.
Preferred Method of Communication:
Group / Entity Type:
Sorority / Fraternity
Street(s) / Block(s) Interested in Adopting: Please be specific of the exact area and ending cross streets
Map of Northridge West Boundaries:
How did you hear about the Adopt-1-Street Program?:
Volunteers Cleaning Communities Website / Event
Friend / Relative
Northridge West Neighborhood Council
ASSUMPTION OF RISK, RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT
Please approve the entire waiver at the completion of the document
In consideration for permitting Participant to participate as a volunteer in activities with Adopt-1-Street, as directed by the relevant staff, the undersigned, for themselves, and for their respective heirs, personal representatives and assigns, agree as follows:
Assumption of Risk: The undersigned hereby acknowledge and agree that they understand the nature of the Event; that Participant is qualified, in good health, and in proper physical condition to participate therein; that there are certain inherent risks and dangers associated with the Event; and that, except as expressly set forth herein, they, knowingly and voluntarily, accept, and assume responsibility for, each of these risks and dangers, and all other risks and dangers that could arise out of, or occur during, Participant’s participation in the Event.
Release and Waiver: The undersigned hereby RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE the Adopt-1-Street and its member institutions, or any subdivision thereof, and each of them, their officers and employees, (collectively, the “Releasees”), from and for any liability resulting from any personal injury, accident or illness (including death), and/or property loss, however caused, arising from, or in any way related to, Participant’s participation in the Event, except for those caused by the willful misconduct, gross negligence or intentional torts of the above parties, as applicable.
Indemnification and Hold Harmless: The undersigned also hereby agree to INDEMNIFY, DEFEND AND HOLD the Releasees HARMLESS from any and all claims, actions, suits, procedures, costs, expenses, damages and liabilities including, but not limited to, attorney’s fees, arising from, or in any way related to, Participant’s participation in the Event, except for those arising out of the willful misconduct.
Permission to Use Likeness/Name: The undersigned further agree to allow, without compensation, Participant’s likeness and/or name to appear, and to otherwise be used in material, regardless of media form, promoting the Adopt-1-Street and/or its current and future events and activities, including those of its representatives and licensees.
Severability: The undersigned expressly agree that the foregoing assumption of risk, release and waiver of liability and indemnity agreement is intended to be as broad and inclusive as is permitted by the law of the State of California and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.
Acknowledgment of Understanding: The undersigned have read this assumption of risk, release and waiver of liability and indemnity agreement, and have had the opportunity to ask questions about the same. The undersigned fully understand this assumption of risk, release and waiver of liability and indemnity agreement, that the undersigned are giving up substantial rights in connection therewith, and that its terms are contractual, and not a mere recital. The undersigned acknowledge that they are signing this agreement freely and voluntarily.
I Understand /Agree to these terms
CLEAN-UP EVENT SAFTY SHEET - Stay safe while doing your part to make the city a more beautiful place to live, work and play. Follow these important safety tips at all times:
Full Name Signature / Date
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