Keep Putnam County Beautiful                                         Clean Commission - Volunteer Waiver and Registration
***PLEASE - Only Family Members Can Be On The Same Form***

I do hereby release, hold harmless, and discharge: "Keep Putnam County Beautiful - Clean Commission," "Keep Tennessee Beautiful," "Keep America Beautiful," "Tennessee Department of Transportation," The State of Tennessee, its officers, agents, board members and employees from any and all liability for injury to my person, damage to my property, or death, whether or not such liability is based upon allegations of negligence while participating in Tennessee's Adopt-A-Highway program and/or other volunteer activities on or near state-owned right-of-way, City of Cookeville, TN or County of Putnam, TN owned property. I acknowledge the fact that working in the area of roads, doing litter clean up and recycling collections can be a hazardous activity, and that I accept the risks associated with this work.

I certify that I have reviewed and fully understand the Adopt-A-Highway Volunteer Safety Guide and have watched in completion the Adopt-A-Highway Safety Video (link below), as a prerequisite to participating in the Adopt-A-Highway program or any other volunteer program.

I certify that I am the responsible party for any minor under the age of 18 during the event and the parent or guardian has signed the consent release form and grant permission for him/her to participate as a volunteer in the Adopt-A-Highway program or other programs that the Keep Putnam County Beautiful - Clean Commission participates in. I further agree to abide by the stipulation set forth in the above paragraphs.

Adopt-A-Highway Safety Guide and Video: https://www.youtube.com/watch?v=qDAfyZRGDNQ&ab_channel=TDOTnews

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