2016-05-01 Bounce House-Great Commission Baptist ChurchCITY OF BLAIR
PROPERTY ACCESS
WAIVER OF LIABILITY
NAME: Great Commission Baptist Church
ADDRESS: Blair, Nebraska 68008
In consideration of being permitted to have a bounce house for event being held in the
park on Sunday, May 1, 2016 from 12:00 p.m. to 6:00 p.m. at the Lions Shelter, 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.
Signature:
Printed Name: Andrew Shank
Phone: (402) 909-2799
Date:
Authorization by City: Date: