COASTAL CLEANUP DAY | PBC Online Sign Up & Waiver of Liability & Express Assumption of Risk

COASTAL CLEANUP DAY 2023 WAIVER OF LIABILITY AND EXPRESS ASSUMPTION OF RISK (PLEASE READ CAREFULLY) 

I understand and agree as follows: 1. I am volunteering my services for Coastal Cleanup Day (“the Event”); 2. I will perform only  those tasks assigned, observe all safety rules, and use reasonable care in the performance of my assignments; 3. I acknowledge that I am engaging in this activity as a volunteer and not as a State of California employee, agent, official, officer or  representative, and further acknowledge that I am not entitled to any compensation, benefit or insurance coverage from the State  of California, the California Coastal Commission, the Department of Parks and Recreation, California State Parks Foundation, or  any agent thereof including any Event promoter, sponsor, or organizer.  

I understand and agree that Event Sponsors and their respective employees, officers, agents or assigns (collectively referred to  as “Released Parties”), are not to be held liable or responsible in any way for any injury, death or other damages to me or my  family, heirs, or assigns that may occur as a result of my participation in the Event, or as a result of product liability or the  negligence, whether passive or active, of any party, including Released Parties, in connection with the Event. The State of  California, the California Coastal Commission, the Department of Parks and Recreation, California State Parks Foundation,  California Department of Fish & Wildlife, California Department of Transportation, City of Pacifica, City of Daly City, Pacific Beach  Coalition, City of San Mateo, San Mateo County, City of South San Francisco, City of Half Moon Bay, City of Foster City, San  Francisco Recreation and Park Department, Golden Gate National Parks Conservancy, San Mateo County Environmental Health,  Santa Clara Valley Water District, Save Our Shores, nor any of their respective employees, officers, agents or assigns, (collectively  referred to as “Released Parties”), or any agent thereof including any Event promoter, sponsor, or organizer. 

In the circumstance of injury or illness, I authorize qualified emergency medical professionals to examine and administer  emergency care to me, regardless of whether I am able to specifically agree to treatment at the time it is administered. I  understand and agree to assume the risks related to medical treatment. 

I understand and agree to assume all risks associated with the cleanup activity, including the use of watercraft. I HEREBY  RELEASE AND HOLD HARMLESS THE RELEASED PARTIES FROM ANY CLAIM OR LAWSUIT FOR PERSONAL INJURY,  PROPERTY DAMAGE, OR WRONGFUL DEATH, BY ME, MY FAMILY, ESTATE, HEIRS, OR ASSIGNS, ARISING OUT OF  PARTICIPATION IN THE EVENT, INCLUDING CLAIMS ARISING DURING THE ACTIVITY AND AFTER I COMPLETE THE  ACTIVITY, AND INCLUDING CLAIMS BASED ON NEGLIGENCE OF OTHER PARTICIPANTS OR THE RELEASED PARTIES.

Sign in to Google to save your progress. Learn more
Date of desired cleanup *
MM
/
DD
/
YYYY
First Name *
Last Name *
Email *
Are you part of a school or other organization?
If yes, please tell us which one.
Address *
street, city, state
Zip Code *
Phone *
Unless I opt out, I agree to allow my image to be used in published materials and websites that promote the programs of the California Coastal Commission or any coastal programs conducted by the Released Parties.
Clear selection
Unless I opt out, I agree that the California Coastal Commission or any coastal programs may contact me about future Coastal Cleanup Day events
and other Public Education programs.
Clear selection
How did you hear about us?
Clear selection
Is the person you are filling out this form for under the age of 18?
 *
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Pacific Beach Coalition. Report Abuse
Google Forms