LIBERTY DAY 2012, CEDAR BLUFF, AL
ENTERTAINMENT APPLICATION
Name________________________________________________________________________________
Street
Address_________________________________________________________________________
City, State, Zip Code__________________________________
Email____________________________
Telephone-Home___________________Work___________________Cell_________________________
We--DO _____ DO NOT _____
carry liability insurance for
this event.
List and describe your talent.
Include additional sheets if needed.
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
HOLD HARMLESS AND INDEMNIFICATION AGREEMENT
We, the undersigned, for and
in consideration of permission and space to participate in the Liberty Day
Festival at Cedar Bluff, Alabama, agree to indemnify, hold harmless and defend
the town of Cedar Bluff, AL, and the Cedar Bluff Parks and Recreation Committee its officials, representatives, agents, servants,
volunteers, from and against any and all claims, action, lawsuits, damages,
judgments, liability and expense, including attorney fees and litigation
expense, in whole or in part arising out of, connected with or in any way
associated with my/our activities preparing for
Liberty Day or departing from Liberty Day. I have read and fully understand the
above Hold Harmless and Indemnification Agreement.
Signature _________________________________________________Date________________________________
Print
Name____________________________________________________________________________________
Signature of Parent/Legal
Guardian (if under 19 years of age) ___________________________________________
Printed Name of
Parent/Guardian__________________________________________________________________
Please return this form to:
C/O Town of
P.O. Box 38
Cedar
For Additional information or questions contact: Town
of Cedar Bluff at 256-779-6121 or email cblibertyday@tds.net
Please note
that your signature on this application does not guarantee you a spot at Liberty
Day.
You will be
notified if you are selected.
OFFICE USE ONLY—DATE REC’D_________________________