2012-05-08 Troop 232 at Neihardt ParkCITY OF BLAIR
PROPERTY ACCESS
WAIVER OF LIABILITY
NAME: Boy Scout Troop 232
ADDRESS: CITY: STATE: vu
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In consideration of being permitted to utilize the Blair y
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undersigned assumes all risks of damage or loss either to his / her person, cast
members and /or crew members from any and all causes, including but not limited to
negligence, violation of law, or willful misconduct on the part of the City of Blair, its
employees or agents, during the time the undersigned has access to the City of Blair
property indicated above. It is understood that the City of Blair, it's employees or
agents, shall incur no liability or obligation to the undersigned, his / her heirs,
successors or assignees for any damages, injury or other loss that the undersigned may
have as a result of his /her gaining access to City of Blair property. Further, the
undersigned must fully comply with all safety requirements of the City of Blair.
THIS WAIVER APPLIES TO THE DATE OR OCCURRENCE THAT THE
UNDERSIGNED HAS ACCESS TO THE CITY OF BLAIR PROPERTY.
Signature:
Printed Name: - 7 c 'jar Z � --, 0, } �-- - a ('4 ;---
Contact Phone: HU Z - S 3— -3 r 05—
Date:
Authorization by City:
Date: 51 ? 1 12. ,
Rod S"fo m, City Administrator
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