Registration form **please mail your registration form, hold harmless agreement, and $50 non-refundable deposit for each child you enroll. name email address city state zip phone: school attending fall 2011 grade fall 2011 t-shirt size (circle...
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Release and hold harmless agreement i, the undersigned participant/parent/guardian, request voluntary participation for myself/minor to participate in the bee healthy, bee green camp/junior bee healthy, bee green camp activity starting june 1,...
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20152016 consent, release, hold harmless and authorization to reproduce physical likeness date: team name: role: o coach/mentor school name: o team leader (adult) o student participant o volunteer this is a consent and release of rights in favor...
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Date: attn: norman bruhn chief building official city of pembroke pines re: hold harmless letter (for all changes of contractor) note: 1 for change of general contractor or prime contractor 2 for change of subcontractor in conjunction with form...
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Admiral insurance company 520 pike street, suite 2929 seattle, wa 98101 phone (206) 4676511 fax (206) 4676557 internet: .admiralins.com 1. medical spa professional liability insurance application (claims made) full name of applicant: (include all...
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Adult hold harmless agreement aedc public affairs industrial area tour in consideration for me being allowed to tour the aedc industrial area, i, the undersigned, intending to be legally bound, agree as follows: 1) to forever release and discharge...
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Reset save as print oregon mutual insurance company po box 808, mcminnville, oregon 97128 800--2141 ? fax 503-565-3841 .oregonmutual.com new appointment application agency name phone number dba (if different from above) fax number start here...
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Hold harmless agreementsaturday, june 21st, 2014it is agreed by the applicant/participant that he/she shall assume full responsibility for, and hold all poolsideservices, inc, event property owners, and event cosponsors harmless and whole from any...
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Economy body shop & towing inc. hold harmless and auto affidavit todays date: year: make: model: vin: tag: state: legal owner: i do hereby release the above vehicle, all possessions, and all legal responsibility to . i understand that i am...
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Butler recreation american red cross course registration form name: phone: address: email: age: circle following: butler student hrc member non-member dates registration deadline wednesday, april 15, 2009 cpr/aed for the professional rescuer...
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Sketch/area table addendum file no 10 1303 buckingham road subject property address city garner county chatham state nc zip 27529 borrower jill booth lender/client l/c address appraiser name e.c. meyer appr address go realty po box 1292, holly...
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Certificate of insurance request form if you are required to provide a certificate of insurance to a vendor, contractor, or other entity for any reason, please supply the following information and fax this form to the office of risk management at...
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Church usage and hold harmless agreement i/we the undersigned, of the city of , state of shall be using the building and grounds of lawton first assembly from to , 20 , for the purpose of , herein referred to as the activity. i/we understand and...
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Change of contractor notice i property owner of (owner name) (property address) wish to change contractors for permit # from ,who is the qualifier for (contractor name) (contractor company) to new contractor of record who is (contractor name) the...
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California state pta insurance does not cover vendors/concessionaires/service providers. consequently, all vendors/concessionaires/service providers are required to provide evidence of insurance to each pta, unless annual evidence of insurance has...
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