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Required fields are marked with an asterisk (*). First name *
Last name *
Middle name
Street address *
Street address (line 2)
City
State
Zip *
Mobile phone
For example, 123-456-7890
Gender
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Race or Ethnicity
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Age range (for demographic use only)
Emergency contact #1 name and phone *
Emergency contact #2 name and phone
The City of Bloomington Parks and Recreation Division is committed to providing reasonable accommodations and accessibility for all residents. Please let us know if you have any specific needs for participation. A staff person will contact you to discuss further.
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City of Bloomington
Adopt-A-Park Program
Program Agreement
The City of Bloomington (“City”), a Minnesota municipal corporation located at 1800
West Old Shakopee Road, Bloomington, Minnesota 55431, acting by and through its
Parks and Recreation Department, and ______________________________
(“Group Organizer”), agree to the terms set forth in this Agreement which governs the
tasks the Group Organizer and all Adopt-A-Park Program participants performing
tasks under their direction will perform at
__________________________________________________________ (“Park”).
Recitals
The City desires to provide interested persons and groups with an opportunity for
community involvement through voluntary participation in its Adopt-A-Park Program
(“Program”).
Group Organizer, and all Program participants to be acting under their direction,
desire to participate in the Program upon the terms set forth in this Agreement.
Agreement
1. Group Organizer and all participants acting under their direction (together, the “Group
Volunteers”) will provide the tasks designated on the “Task Agreement Form”
attached to this Agreement as Exhibit A and incorporated herein. Group Volunteers
will not perform any tasks which the City has not previously approved through the
Task Agreement Form.
2. Group Volunteers and will not assign to, subcontract, or hire others to perform tasks
hereunder. The City may perform or cause others to perform the activities listed on
the Task Agreement Form, at its discretion.
2. This Agreement expires at the end of the calendar year in which it was executed.
Nothing shall be construed herein as authorizing any renewal or continuance of this
Agreement past the last day of the calendar year in which it was signed and dated.
3. Group Organizer, or their designee, shall ensure that Group Volunteers are adequately
trained and properly supervised for all tasks they perform under this Agreement, including in the use of any tools a Group Volunteer operates while performing tasks under this Agreement.
4. Unless otherwise agreed to between the parties, Group Volunteers will furnish, at their own expense, all tools, materials, supplies, labor and services and other accessories in connection with this Agreement and will ensure that these items are removed from the Park at the end of each day.
5. The use of power tools by Group Volunteers is prohibited. Group Volunteers will only use non-powered, hand-operated tools. Group Volunteers shall take all necessary precaution to prevent injuries to other Group Volunteers or members of the public.
6. Group Organizer shall ensure that all Group Volunteers read and abide by the “Safety Guidelines” attached to this Agreement (Exhibit B), which is incorporated herein. Group Volunteers shall follow the Safety Guidelines at all times they are performing tasks under this Agreement.
7. Group Organizer and all Group Volunteers will review sign the City’s Liability Waiver attached to this Agreement (Exhibit C), which is incorporated herein. No person shall perform tasks under this Agreement without having signed the Liability Waiver.
8. Group Organizer and Group Volunteers shall be responsible for any and all claims, causes of action, lawsuits, damages, losses or expenses, including attorney fees, arising out of or resulting from the Group Volunteers’ performance of the tasks covered under this Agreement. This provision survives termination of this Agreement.
9. Group Organizer and Group Volunteers will not discriminate against any person desiring to perform services under this Agreement due to the person’s race, color, creed, religion, national origin, disability, age, gender, affectional preference, marital status or status with regard to public assistance.
10.Group Volunteers and any other persons who may perform any tasks covered under this Agreement shall not be considered employees of the City. City is not responsible or liable for any injury or any other claims, expenses, or losses sustained by such
persons while engaged in any of tasks covered under this Agreement. This provision survives termination of this Agreement.
11.Either party may terminate this Agreement at any time upon written notice to the other party.
12.Authorized Agents. The parties’ authorized agents (“Agents”) for purposes of this Agreement are:
Dave Hanson, or successor
Assistant Director of Parks and Natural Resources
1800 West Old Shakopee Road
Bloomington, MN 55431
962-563-8765
dhanson@bloomingtonmn.gov
13.Notice. Any notices permitted or required by this Agreement shall be deemed given when personally delivered, upon deposit in the United States first class mail, addressed to the party’s Agent, or upon transmission of electronic mail, addressed to the party’s Agent.
14.Signatory. Each person executing this Agreement (“Signatory” represents and warrants that they are duly authorized. Group Organizer represents and warrants that has authority to sign this document on behalf of all Group Volunteers.
15.Data Practices. Any and all data provided to Group Volunteers, received from Group Volunteers, collected, created, received, stored, used, maintained or disseminated by Group Volunteers pursuant to this Agreement shall be administered in accordance with, and is subject to the requirements of the Minnesota Government Data Practices Act, Minnesota Statutes, Chapter 13. This provision survives termination of this Agreement.
School/program name:
Waiver
I state and affirm that I will volunteer to tend the garden and adjacent area at Pond-Dakota Mission Park:
1. My participation is voluntary and no one is requiring me to participate. I am not an employee of the City while participating in this Activity, and understand and agree that I shall not be considered an employee of the City and shall not be entitled to payment for any services rendered, Compensation benefits, or any other benefit from the City.Workers
2. I acknowledge the Activity is not an essential service provided by the City.
3. I understand and acknowledge that the Activity I am about to voluntarily engage in has certain inherent risks or dangers. I understand these risks or dangers, known or unknown, anticipated or unanticipated, may result in injury, illness, disease, death or damage to myself or my property, or to other persons and their property.
4. In consideration of being allowed to participate in this Activity, I hereby personally assume all risks in connection with this Activity. I hereby agree to waive and hold harmless the City, its officials, employees and agents from and against any and all claims, injuries, damages, and all causes of action of any nature arising out of my participation in the Activity, whether or not caused by the act, omission, negligence or other fault of the City. I hereby acknowledge and further agree to indemnify the City, its officials, employees and agents from and against any and all claims, injuries, damages and all causes of action arising out of my malfeasance, willful neglect of duty, reckless conduct, gross negligence, criminal conduct or bad faith.
5. I hereby acknowledge and agree that this Waiver of Liability and Release is intended to be as broad and inclusive as permitted by the laws of the State of Minnesota. If any portion is held to be invalid, it is further agreed that the remainder shall continue in full legal force and effect.
6. I understand that entering into and signing this Waiver of Liability and Release affects my legal rights and that I am giving up or waiving certain legal rights. I hereby accept this and am signing this Waiver of Liability and Release of my own free will.
7. The terms of this Waiver of Liability and Release shall bind me, my family members, heirs and assigns and the volunteer.
8. My signature certifies that I have read this entire document, understand it completely, acknowledge that it cannot be modified or changed in any way by oral representation, and agree to be bound by its terms.
9. I grant the City, its representatives, and employees the right to take, use and publish photographs of me with or without my name for any lawful purpose.
I state and affirm that I will volunteer to tend the garden and adjacent area at Pond-Dakota Mission Park:
1. My participation is voluntary and no one is requiring me to participate. I am not an employee of the City while participating in this Activity, and understand and agree that I shall not be considered an employee of the City and shall not be entitled to payment for any services rendered, Compensation benefits, or any other benefit from the City.Workers
2. I acknowledge the Activity is not an essential service provided by the City.
3. I understand and acknowledge that the Activity I am about to voluntarily engage in has certain inherent risks or dangers. I understand these risks or dangers, known or unknown, anticipated or unanticipated, may result in injury, illness, disease, death or damage to myself or my property, or to other persons and their property.
4. In consideration of being allowed to participate in this Activity, I hereby personally assume all risks in connection with this Activity. I hereby agree to waive and hold harmless the City, its officials, employees and agents from and against any and all claims, injuries, damages, and all causes of action of any nature arising out of my participation in the Activity, whether or not caused by the act, omission, negligence or other fault of the City. I hereby acknowledge and further agree to indemnify the City, its officials, employees and agents from and against any and all claims, injuries, damages and all causes of action arising out of my malfeasance, willful neglect of duty, reckless conduct, gross negligence, criminal conduct or bad faith.
5. I hereby acknowledge and agree that this Waiver of Liability and Release is intended to be as broad and inclusive as permitted by the laws of the State of Minnesota. If any portion is held to be invalid, it is further agreed that the remainder shall continue in full legal force and effect.
6. I understand that entering into and signing this Waiver of Liability and Release affects my legal rights and that I am giving up or waiving certain legal rights. I hereby accept this and am signing this Waiver of Liability and Release of my own free will.
7. The terms of this Waiver of Liability and Release shall bind me, my family members, heirs and assigns and the volunteer.
8. My signature certifies that I have read this entire document, understand it completely, acknowledge that it cannot be modified or changed in any way by oral representation, and agree to be bound by its terms.
9. I grant the City, its representatives, and employees the right to take, use and publish photographs of me with or without my name for any lawful purpose.
Check here to indicate that you accept the terms stated above for yourself or for a minor volunteer for whom you are the legal guardian. THE DIGITAL SIGNATURE OF A LEGAL GUARDIAN IS REQUIRED FOR MINORS.
