2012-07-20r
G...
NAME: & JiASO n,
r
ADDRESS: C f o CITY: Mail, STATE:
In consideration of being permitted to mow /bail hay in the Blair City Neihardt
Park facilities sometime between July 20, 2012 to August 13, 2012, the 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: Date:
Printed Name: Clark Jenson, 9110 Co. Rd P35, Blair, NE 68008
Phone: (402) 426 -3198
x
Authorization by City: Date: -1 1Z4 112.
Brenda Wheeler, City Clerk