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CITYOFSANTAANA , RISK MANAGEMENT. d ,6HUMAN RESOURCES <br />Al� to Jc ltK Rrsk ,;- -_,V. positive Change <br />F <br />} <br />WAIVER AND LIABILITY RELEASE FORM <br />In consideration of being permitted to participate in <br />("the Event") I hereby <br />assume all responsibility for any and all risk of property damage or bodily injury <br />employees and/or personnel connected to my operations may cause or su t� nl while <br />participating in the Event, including my participation in activities and the use of equipment while <br />participating or providing services at the Event. <br />Further, I, for myself and my heirs, executors, administrators and assigns, hereby release, waive <br />and discharge the City of Santa Ana and its officers, directors, employees, agents and volunteers <br />of and from any and all claims which I or my heirs, administrators and assigns ever may have <br />against any of the above for, on account of, by reason of or arising in connection with my <br />participation or presence at the Event site, and hereby waive all such clai <br />causes of action. ms, demands and <br />Further, I expressly agree that this release, waiver and indemnity agreement is intended to be as <br />broad and inclusive as permitted by the State of California, and that if any portion thereof is held <br />invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. <br />Further, I have carefully read the foregoing release and indemnification and understand the <br />contents thereof and sign this release as my own, free act. <br />Z-3t- 4 -L— <br />P. TNAME: <br />SIG TURE J <br />OA E: <br />REVIEWED & APPROVED <br />Rv/Rlsk MANAGEMENT DIVISION <br />12019 <br />M. LAMBERT <br />