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specific location of the meeting.
9.
The Pender County Library (910-259-1234) and Pender County Parks and Recreation (910-259-
1330) each have more specific policies and documentation for use of their facilities. Please contact
them directly for their specific requirements.
10.
The undersigned covenants not to sue or to assert any claim against Pender County, its
Commissioners, agents or employees, or any other person, firm, corporation or other entity with
respect to any injury or any other consequence arising out of or related in any way to the
undersigned's use of, presence at, ingress to or egress from, the County Facilities.
Futhermore, the undersigned hereby releases Pender County, its Commissioners, agents or
employees, or any other person, firm, corporation or other entity from any and all claims, demands,
damages, actions and causes of action, suits, losses and liabilities, however denominated, whether
known or unknown, contingent or absolute, apparent or unapparent, accrued or unaccrued, arising
out of or related in any way to:
(a) the undersigned's use of, presence at, ingress to or egress from said County Facilities;
(b) any act, omission, event, incident, transaction or occurrence of any person, firm, corporation
or other entity on or in the vicinity of said County Facilities; and
(c) any circumstance or condition (latent, obvious or otherwise) in or near the vicinity of
said County Facilities.
And furthermore, the undersigned hereby expressly assumes any and all risk or consequences
arising out of or related in any way to:
(a) the undersigned's use of, presence at, ingress to or egress from said County Facilities;
(b) any act, omission, event, incident, transaction or occurrence of any person, firm, corporation
or other entity on or in the vicinity of said County Facilities; and
(c) any circumstance or condition (latent, obvious or otherwise) in or near the vicinity of
said County Facilities.
It is also understood the undersigned is responsible for any damages that may occur to the County Facilities during
the time of usage and further agrees to reimburse the County for the cost of repair.
The undersigned has had a full and fair opportunity to read, consider the same and obtain legal or other advice; and
the undersigned represents to Pender County, and acknowledges that such representation is material and
may reasonable be relied upon by Pender County, that the undersigned has read, understands, and fully consents and
agrees to the foregoing.
For Office Use:
Please return form to Pender County Manager's Office (or Agriculture Extension Service)
805 S. Walker Street, P.O. Box 5 Burgaw, NC 28425
Phone 910.259.1200
Fax 910.259.1402
Applicant Signature:
Date:
Approved:
Special Conditions:
County Staff Signature:
Date:
