Form Center

By signing in or creating an account, some fields will auto-populate with your information.

Participant Waiver

Sign in to Save Progress

Steps

  1. 1. Step One (current)
  2. 2. Participant Information
  3. 3. Required Parent/Guardian Signature for Minor Participants

  • Step One

    2. WAIVER

    4. ROMEOVILLE PUBLIC WORKS DEPARTMENT– PARTICIPANT AGREEMENT 

      NOTE: THIS AGREEMENT MUST BE SIGNED BY ALL ADULT PARTICIPANTS AND MUST ALSO BE SIGNED BY A  

      PARENT OR GUARDIAN OF ANY MINOR SEEKING TO PARTICIPATE IN ANY PUBLIC WORKS PROGRAM OR ACTIVITIES 

      WAIVER AND RELEASE OF ALL CLAIMS AND ASSUMPTION OF RISK

      I acknowledge and assume the risks of property damage, accidents, injuries (including death), loss of bodily functions, disabili-ties, medical disorders, pain and suffering, lost income and medical expenses that arise from participation in any program or activity offered by the Department, and any use of facilities, transportation services, premises and equipment provided by the Department. I further acknowledge that the foregoing risks may arise from my own action or inaction, the actions or inaction of other program participants, the conditions under which a program or activity is conducted, or from the negligent actions or inac-tion (including any failure to warn) of Department personnel, contractors or service providers.  I also acknowledge that from time to time, the Village of Romeoville and/or the Department may take photographs of me participating in the program offered by the Department for use and publication in various publications or media, including but not limited to the Village’s website, Facebook account or other social media sites or accounts, department program brochures or materials, and Village or Department informa-tional, promotional or marketing materials, and I hereby expressly grant to the Village of Romeoville and the Department the right to use and publish such photographs as contemplated herein, all without compensation or payment for such use and publication.  In consideration of being allowed to participate in programs or activities offered by the Department, or to use facilities, transporta-tion services, premises and equipment provided by the Department, I hereby release, waive and discharge the Village of Romeo-ville and its officers, officials, employees, agents, volunteers and contractors (collectively, the “Releasees”) from any and all liability and all claims of any kind whether for personal injury, property damage or death, arising from participation in any activity or pro-gram offered by the Department, arising from my use of facilities, transportation services, premises and equipment provided by the Department, or arising from the use or publication by Releasees of photographs of me participating in programs or activities offered by the Department, whether or not caused by the negligence of the Releasees or any of them and further covenant that I shall not sue any of the Releasees with respect to any such liability or claims. In the event that I or anyone else nonetheless makes a claim or files suit against Releasees arising out of any of the above-described matters, I will indemnify and hold Releasees harmless of and from any and all damages or judgments and costs of litigation, including attorney fees.  The provisions hereof are to be construed as broadly as possible in favor of Releasees, and this Agreement as a whole shall be governed by the laws of the State of Illinois (without reference to the conflicts of laws rules thereof). If any part of this Agreement shall be ruled invalid by a court hav-ing jurisdiction, the balance shall be enforced to the maximum possible extent. I am signing this Agreement freely and voluntarily, having read and understood it and with a full opportunity to consider its substance and with the intention of fully and unconditionally assuming the risks and releasing the liabilities as described above in this Agreement.