Second Saturday Service

2. Participant Information
4. First Name*
5. Last Name*
6. Email Address*
8. Group name (if applicable)
10. Address*
12. City*
13. State*
14. Zip Code*
16. Phone Number
18. Emergency Contact Information
20. First Name*
21. Last Name*
23. Phone Number*
24. Email Address
26. Informed Consent; Liability and Hold Harmless; Publicity Permission

28. I understand that on one or more occasions I/my child will be performing litter clean-up work as part of the Town of Fort Mill and Anne Springs Close Greenway sponsored Second Saturday Service (S3) program.  I have read, and am familiar with the Safety Guidelines provided to me by the Town of Fort Mill and Anne Springs Close Greenway, and agree to comply with said conditions and guidelines.  I understand that litter clean-up activities have a potential risk of injury.  I agree that I/my child will only perform those activities that I am/my child is capable of doing and able to do, and I acknowledge and assume the risks of all such activities.  I understand that participation in the stream clean-up activities is strictly voluntary and that I/my child may cease the volunteer activity at any time.

    I agree that I will not hold the Anne Springs Close Greenway or the Town of Fort Mill or any of its agents, officers, employees, or representatives responsible for any damage or injury to me/my child or my/my child’s property as a result of volunteer participation in the Second Saturday Service program.  I further agree to release, indemnify and hold harmless the Anne Springs Close Greenway and the Town of Fort Mill and all of its agents, officers, employees, representatives, successors and assigns from any and all damages, claims and/or liability arising out of my/my child’s activities as a volunteer stream clean-up participant in the Second Saturday Service program.

    I give permission to the Town of Fort Mill and the Anne Springs Close Greenway to include me/my child in any video productions or photographs that are made to document or publicize litter clean up activities.

30. Electronic Signature

    By typing your name, you are electronically signing this waiver.  Must be completed by all participants over age 18.  For participants under 18, a parent/guardian must electronically sign. 

32. First Name*
33. Last Name*
34. Date*
    Date

    Date
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36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit Submit and Print

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