Public Works Department Bureau of Facilities & Environment Environmental Services Division
Adopt a Spot Program 250 Frank H. Ogawa Plaza, Suite 5301, Oakland CA 94612
VOLUNTEER WAIVER & RELEASE OF LIABILITY
I, ______________________________________, am voluntarily participating in the Oakland
Public Works volunteer program at ________________________. I have read and agree to follow the Volunteer
Guidelines. I acknowledge my participation in these events does not come without the risk of injury or harm; I
accept this risk, and assume responsibility for all liability and risk associated with my participation.
I agree to hold harmless, release, waive and forever discharge the City of Oakland, its
employees, departments, officers and agents, from any and all claims or demands I may have by reason of any
accident, illness, injury, loss, destruction or damage to property, arising or resulting directly or indirectly from my
participation in this activity. I further covenant not to bring any legal action against the City of Oakland, its
employees, departments, officers and agents, for any injury, loss or damage resulting from my participation in this
activity.
This Waiver and Release is contractual and not a mere recital and applies whether or not injury
or loss resulting from this activity is caused by an act or omission of the City, its employees, departments, officers
or agents, negligent or otherwise.
This Waiver and Release is binding on my heirs, executors, administrators, assigns, and all of my
family members, and applies to all losses, whether known or unknown, suspected or unsuspected, related to my
participation in this activity.
I hereby grant permission to the City of Oakland to use photographs and video of me taken
during this activity on its website and in other publications, at the City’s sole discretion and without further
consideration.
This Waiver and Release was executed on ______________, 20___ in Oakland, California and is
valid for a 12 month period from the date of signing.
_________________________________ ______________ ___________________________ ____________
Print Participant’s Name Age (if under 18) Signature of Participant* Date
*If under 18 years old, parent or guardian must also sign below
_______________________________ ____________________________
Print Parent/Guardian Name Signature of Parent/Guardian
This form and a version that accommodates multiple signatures are available at
www.oaklandadoptaspot.org
.
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