Adopt-a-Block Supplemental Registration Form
Please Note: Adult supervision is NOT provided by the City of Hayward at this event. All volunteers under the age of 18 must be accompanied by a participating adult. Thank you.
Sign in to Google to save your progress. Learn more
Name of Group that you are representing *
1.) First Name *
Must be over the age of 18 to register
Last Name *
Date of Birth *
MM
/
DD
/
YYYY
2.) Will a participant under the age of 18 be accompanying you? *
If no, please proceed to question #3
Please list the names and ages of all minor participants
3.) Mailing Address *
4.) Email Address *
5.)Telephone Number *
The Important Stuff
Please Note: Adult supervision is NOT provided by the City of Hayward at this event. All volunteers under the age of 18 must be accompanied by a participating adult. Thank you.
I, the undersigned, being of lawful age or the parent or legal guardian of the volunteer involved in the City of Hayward litter pickup effort, in consideration of being allowed to participate in this effort, hereby agree as follows:
1. I, personally and on behalf of my heirs, personal representatives, executors and assigns, and on behalf of the minor and the minor’s heirs, personal representatives, executors and assign, hereby release, waive, discharge, and covenant not to sue the City of Hayward, its City Council, and City departments or subdivisions, its employees, representatives, officers, agents, volunteers, and successors and assigns, (hereinafter collectively referred to as “Releasees”), from any and all claims, demands, actions, causes of action, judgments, costs, expenses, attorneys’ fees or other damage or liability, on account of, or in any way related to, or arising out of my participation, or the minor’s participation, in the City of Hayward litter pick-up event. *
2. I, personally or on behalf of the minor, agree to defend at my expense, pay on behalf of, indemnify and hold harmless, Releasees from and against any and all claims, demands, liens, liabilities, judgments, losses and damages including, but not limited to, costs, expenses and attorneys fees, for damage to property or bodily or personal injuries, including death resultingtherefrom, sustained by any person or persons, which damage or injuries are alleged or claimed to have arisen out of or in connection with, in whole or in part, directly or indirectly, my participation, or the minor’s participation, in the City of Hayward litter pick-up event. *
3. I, personally or on behalf of the minor, agree to assume liability for any non-participants who accompany me or the minor during the City of Hayward litter pick-up event. *
4. I, personally or on behalf of the minor, hereby give the City of Hayward, its employees, representatives, officers, agents, volunteers, and successors and assigns, permission to take and use interviews, photographs, or videotapes of myself and/or the minor for promotional and educational purposes. This publicity may include publication of the photographs in publications, posters, brochures and newsletters, on the City’s website, radio station, or cable television channel, or other forms of publicity for the City. I understand there is no monetary compensation for the use of these photographs. *
Please Review Clean-Up Event Safety Sheet
I, the undersigned, being of lawful age or the parent or legal guardian of the volunteer involved in the City of Hayward litter pickup effort, have read the above paragraphs and the attached safety sheet, fully understand, and voluntarily sign this Agreement and agree to be bound by its terms.   :
Full Name *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms