Form Center

2. TITLE

   City of Harrisonville Block Party Waiver

   Hold Harmless Agreement & Release of Liability

4. In consideration for the privilege of participating in the block party at:
6. The undersigned hereby agrees that:
   1. I understand there are inherent risks involved in a block party, including the risk of serious physical injury or death and I FULLY ASSUME ALL RISKS ASSOCIATED WITH A BLOCK PARTY, including but not limited to: lack of cones; potholes; streets conditions; electrical issues; trip hazards; alcohol; loud music; fire; explosions; collisions with vehicles; barriers; volunteers; other patrons and spectators; equipment failure; lack of warnings or inadequate warnings; lack of instructions or inadequate instructions; and the like.
   2. I, for myself and for my heirs, assigns, successors, executor, administrators, and legal representatives, AGREE TO DEFEND, INDEMNIFY AND HOLD HARMLESS THE CITY OF HARRISONVILLE, MISSOURI AND THEIR AGENDS SERVANTS OR EMPLOYEES from any and all claims, suits or demands by anyone arising from my use of the city street to host the block party, INCLUDING CLAIMS OF NEGLIGENCE ON THE PART OF THE CITY OF HARRISONVILLE, MISSOURI AND THEIR AGENTS, SERVANTS OR EMPLOYEES. If the event provides bounce houses, rides, animals, or activities/competitions with any predictable risk of injury that may take place on /city Property, the Block Party organizers must provide proof of liability insurance in the amount of one million dollars ($1,000,000.00) to the City Clerk at least five (5) days prior to the event date. Failure to meet this requirement shall made the permit null and void.
   3. I, for myself and heirs, assigns, successors, executors, administrators, and legal representatives, HEREBY RELEASE AND AGREE THAT I WILL NO SUE THE CITY OF HARRISONVILLE, MISSOURI AND THEIR AGENTS, SERVANTS OR EMPLOYEES for money damages for personal injury sustained by me while using the city street to host a block party EVEN IF DUE TO THE NEFLIGENCE OF THE CITY OF HARRISONVILLE, MISSOURI AND THEIR AGENTS, SERVANTS OR EMPLOYEES.
   4. The City of Harrisonville Police Department reserves the right and has the authority to shut down, cancel and or terminate this event at any time. The City of Harrisonville Police Department also has the right to decline any future events, if this event causes any calls for service or creates a hazard or nuisance to the neighbors and or complaints.

   
   

   I HAVE READ THIS WAIVER, HOLD HARMLESS AGREEMENT AND RELEASE OF LIABILITY AND FULLY UNDERSTAND ITS TERMS. I FURTHER UNDERSTAND THAT BY SIGNING OR COMPLETING THIS AGREEMENT, I AM GIVING UP SUBSTANTIAL LEGAL RIGHTS. I HAVE NOT BEEN INDUCED TO SIGN OR COMPLETE THIS AGREEMENT BY ANY PROMISE OR REPRESENTATION, AND I SIGN IT VOLUNTARILY AND OF MY OWN FREE WILL.

8. First Name
9. Last Name
11. Address
13. Date
14. Phone Number
Leave This Blank:


16. 1. Receive an email copy of this form.
17. Email address

    This field is not part of the form submission.

18. Submit

* indicates a required field