TOWNSHIP OF MEDFORD

APPLICATION FOR SPECIAL EVENT SOLICTOR’S PERMIT

RELEASE FORM

This applicant listed below has applied to the Township of Medford for the purpose of securing a Special Event Solicitor’s Permit at the designated Medford Township facility.

In accepting this permit, the applicants (for itself, its members, and invitees) accepts and assumes the risk of all conditions existing in the area covered by this permit and the approaches thereto and agrees to hold harmless the Township of Medford and its employees from all risks, liability, injury, damage, and loss to all persons and property arising out of or resulting from any use of or presence within the areas covered by this permit; and also agrees to waive and relinquish all claims and causes of action of every kind; and agrees to indemnify Medford Township for the defense of any such claims or action-whether the liability, loss, or damage is caused by, or arises out of the negligence of the Township of Medford or any of the agents, employees or otherwise.

We further agree to reimburse the Township Medford for any and all expenses, attorney fees or other costs incurred in the enforcement of this waiver and indemnification.

On behalf of this applicant, we understand all procedures associated with this request and accept the legal and financial responsibilities involved in the vending within Medford Township facilities.

Printed Name of Applicant / Business

Location Requested

Date(s) Requested

Signature – Authorized Applicant Representative Date

Signature – Authorized Applicant Alternate Representative Date