Department of Parks & Recreation
Please provide the following information, read the release, enter your name
(considered an electronic signature) at the bottom, and click "Submit." Thank you very much.
Park/Location of activity:
Volunteer's Age (req'd if under 18):
Volunteer's First Name:
Emergency Contact/Phone Number:
Physician's Name/Phone Number:
LIABILITY WAIVER AND RELEASE
I the undersigned, being the participant or the parent or legal guardian of the participant if under age 18, in consideration of permission to participate in the Township’s “Adopt-A-Park” program (the "Program”), recognize that the Program includes exposure to natural hazards such as rose bushes, trees, ticks, poison ivy, cold weather, mud, etc. Recognizing these hazards of the outdoors, I (we) hereby release the Township of Lower Merion, its officers, agents, employees, sponsors, organizers and all leaders assigned by them from any and all actions, causes of action, claims or any other liabilities whatsoever for any damage and/or injury to any person or thing in connection with the above activity. Furthermore, I hereby agree to refrain from bringing suit against any of the above named on my own behalf or on behalf of the minor child (named above) as a result of any damage or injuries to any person or thing that occurs in connection with the above activity.
Adult Participant's/Parent's Signature:
Lower Merrion Department of Parks and Recreation main phone number: 610-645-6220