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2. General Liability Waiver

   The undersigned participant, on behalf of itself, its dependents, employees, officers, volunteers and agents, hereby releases, waives, and agrees to hold harmless the City of Huber Heights, as well as their officers, employees, agents, and volunteers, from and against any and all claims, losses, causes of action, judgments or damages (including consequential damages), of any kind or nature, arising out of or related to: the participant’s use of City-owned property or program participation as authorized; operation or activity conducted by or on behalf of the applicant, applicant’s dependents, employees, agents or invitees during the time of use; the terms of this form and release.

   I also hereby grant permission to the City of Huber Heights use photos of myself, dependents, employees, officers, volunteers and agents that may result from participation in public programing or use of public space. Examples of typical use include but are not limited to web and print publications, advertisements and internal reports.

   I have read and agree to abide by the terms and conditions of this form and release and enter into it voluntarily and knowingly. This form and release is binding when signed by the applicant and the waiver, release and indemnity provisions shall survive the conclusion of the time of use or participation.

   
   

4. What program are you participating in?
6. First Name
7. Last Name
9. Address
11. City
12. State
13. Zip Code
15. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
17. Electronic Signature
19. Email
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21. 1. Receive an email copy of this form.
22. Email address

    This field is not part of the form submission.

23. Submit

* indicates a required field