2013-09-13A..
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TAME: Sterling Transportation
ADDRESS: 310 Eastgate Dr, Nebraska 68008
In consideration of being permitted to utilize special recreation equipment on Thursday,
September 19, 2013 from 10:00 a.m. to 8:00 p.m. at the Depot located in Lions Park
Blair, Nebraska, special recreation equipment being further described as "Tomahawk
Tossing Contest ", the undersigned assumes all risks of damage or loss either to his /
her person, guests or property 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.
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Signature: Date: q-- //—/3
Printed Name: ° �
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Authorization by City: - Date: