Youth Name *

First Name

Last Name

Youth Phone (if applicable)

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Parent Name *

First Name

Last Name

Parent Phone *

(###)

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Volunteer Agreement & Release of Liability *

Hold Harmless & Media Agreement: I understand that my child is volunteering or fulfilling community service hours with Keep Durham Beautiful. I recognize that this is a VOLUNTARY program and agree to HOLD HARMLESS Keep Durham Beautiful, Inc., the City/County of Durham, partnering organizations, and volunteer helpers, for injuries and negligence as a result of this effort to beautify Durham. I give permission for any photographs, recordings, interviews, videotapes, motion pictures or similar visual or auditory recording of me or my child in connection with this project to be used by Keep Durham Beautiful, Inc. for educational or promotional purposes in print or electronic. BY TYPING MY NAME BELOW, I AM INDICATING THAT I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A LIABILITY WAIVER, AND RELEASE AGREEMENT FOR MY CHILD’S PARTICIPATION IN THESE ACTIVITIES, AND SIGN IT OF MY OWN FREE WILL AS GUARDIAN OF THE CHILD INDICATED BELOW.

I agree to the Terms and Conditions.