application form

Adopt - A - Spot Program

 


The person or business adopting a spot agrees to be responsible for purchasing, planting and maintaining the spot adopted and understands that in assuming this responsibility there may be certain risks involved.  Accordingly, by signing this document, the person or business agrees to forever discharge and release the Town of Berwick, its officers, agents and employees, from all actions, causes of action, damages, claims or demands whatsoever, including, but not limited to, claims basd on the negligence of the Town or its employees related in any way to the volunteer work which may be undertaken.

I further state that there are no medical or physical limitations on me of which I am aware which would prevent me from performing this volunteer work for the Town of Berwick and that I am covered by a policy providing health/accident insurance coverage.

I understand that I am under no obligation to perform volunteer work but that I am assuming the responsibility for maintaining this Adopt-A-Spot as long as I am able to. 

I will notify the Town if I can no longer maintain this Spot.

 

  Signed:            ______________________  

Spot  Address:      ______________________

                        ______________________

Telephone No.    ______________________

Date:                        ______________________