GCLBA General Release of Liability

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All individuals are required to complete this form PRIOR to accessing Land Bank property.

Completion of this form means that you agree to the statement below.

Liability Release: Entry onto Genesee County Land Bank Property

It is understood that included in the definition of “Property” is any property with or without structure.

I do hereby agree to indemnify and hold harmless Genesee County, the Genesee County Lank Bank Authority, their respective Board of Commissioners and Board of Directors, and their administrators, agents and employees from any and all liability for property damage and/or bodily injury to anyone or anything that arises from or is caused by actions or omissions taken in furtherance of my efforts related to the Property.

I understand that the Property may be in poor condition and presents potential hazards. I take full responsibility for entering the Property and taking appropriate care while on the Property.

Parcel ID(s) *

Address(es) *

Purpose of visit to the property? (check all that apply) *

Attend an open house

Mow and maintain property

Complete a clean up

Plant a flower garden

Plant a food garden

Remove tree limbs/branches or brush

Board doors and/or windows

Other:

Required

First Name *

Last Name *

Your Address *

SIGNATURE *

By entering your name in the box below this acts as a legal binding digital signature

Parent/Guardian E-Signature (if the participant is a minor)

Submit

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