I confirm that I am 19 years of age or older.

I confirm that I have read the OveNiew of the Village of Anmore’s Adopt a Street Program (“OveNiew”) and the Adopt a
Street Safety Guide (“Safety Guide”), understand that they are the terms and conditions of my participation in the Village
of Anmore’s Adopt a Street (“Program”) and I agree to adhere to such terms and conditions.

I agree to take care to minimize the risks associated with the Program and while participating in the Program, I will wear
a safety bib, gloves, and appropriate footwear and to use equipment, tools and materials provided by the Village. I will
promptly notify the City in the event I am injured or property is damaged while I am participating in the Program.

I understand that I am free to withdraw from or reduce my participation in the Program at any time.

I acknowledge that there are dangers, risks and hazards associated with participation in the Program including, but not
limited to, the risk of injury, contact with dangerous debris, slips or trips and falls on slippery or uneven surfaces, and
collision with passing traffic, and freely accept and assume all dangers, risks and hazards associated with the Program.
understand that the Village’s workers’ compensation coverage does not apply to me as a volunteer and that the Village’s
insurance covers only basic contingent accident medical coverage for volunteers.

1. Covenant not to sue and hereby waive, release and discharge the Village, and anyone acting for or on the Village’s behalf, from any and all claims of liability for injury, loss or damage of any kind or nature, arising out of or sustained in the course of my participation in the Program. This Release and Waiver applies to all claims, foreseen or unforeseen, including negligence and breach of statutory or other duty of care (including that owed under the Occupier’s Liability Act).

2. Hold harmless, release and indemnify the Village from any and all liability for any loss, damage, injury or expense that I may suffer or that any of my dependants may suffer as a result of the Program due to any cause whatsoever including, without limitation, negligence, breach of contract or breach of any duty of care under the Occupiers Liability Act (British Columbia) or other enactment on the part of the Village.

I recognize that by signing this document I am waiving certain legal rights, including the right to sue.