Community Service Release
Attachment B
VILLAGE OF NORTH PALM BEACH
“THE BEST PLACE TO LIVE UNDER THE SUN”
STUDENT VOLUNTEER COMMUNITY SERVICE
HOLD HARMLESS AGREEMENT
RELEASE & INDEMNIFICATION FORMS
I, _____________________________, the undersigned, do hereby acknowledge and agree as follows:
In consideration of being permitted by the Village of North Palm Beach (the Village) to perform labor tasks for an on
behalf of the Village in fulfillment of my Community Service requirements, I Hereby agree to indemnify and save
harmless the Village and its agents and employees from and against any and all claims, suits, actions, damages and/or
causes of action arising while performing labor tasks for and on behalf of the Village in fulfillment of my Community
Service requirements, for any personal injury, loss of life and/or damage to property sustained by me or to any other
person resulting from any accident or incident which may occur as a result of my performing labor tasks for and on
behalf of the Village in fulfillment of my Community Service requirements whether by negligence or not, and from and
against any order, judgements, and/or decrees which may be entered thereon, and from and against all costs, attorneys
fees, expenses and liabilities incurred in and about the defense of any such claim. In the event that the Village shall be
made a party to any litigation commenced against me or by me against any third party, then I agree to protect and hold
the Village harmless and pay all costs and attorney fees incurred by the Village in connection with such litigation and for
any appeals thereof.
I assume full responsibility for any risk of bodily injury, death or property damage due to my negligence or otherwise
while performing labor tasks for and on behalf of the Village in fulfillment of my Community Service Requirements.
I agree that this release, waiver, and indemnity is intended to be as broad and inclusive as permitted by the Laws of the
State of Florida and that if any portion of this agreement is held invalid, I agree that the balance shall continue in full
force and effect.
This Release contains the entire agreement between me and the Village and the terms of this Release are contractual
and not a mere recital.
EXECUTED THIS________Day _________,20_______ ____________________________
Emergency Contact Name & Tel #
______________________________________________ ____________________________
Signature Social Security Number
______________________________________________ ____________________________
Parents / Guardian Signature Drivers License Number
SUBSCRIBED AND SWORN to (or affirmed) before me this _________day of________, 20________
By____________________________________. STATE OF FLORIDA: COUNTY OF PALM BEACH:
(SEAL)
______________________________________
Notary Signature