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S`Jbmit aiding Internet'plorer'ONLY) <br /> Page 1 of 4 <br /> Revised: 12-28-17 <br /> SPECIAL EVENT SPONSOR <br /> WAIVER,RELEASE AND INDEMNIFICATION AGREEMENT <br /> City of Pequot Lakes <br /> 4638 Main Street <br /> Pequot Lakes,MN 56472 <br /> THIS IS A WAIVER, RELEASE OF LIABILITY AND INDEMNIFICATION <br /> AGREEMENT. SPECIAL EVENTS HOLDER MUST READ CAREFULLY BEFORE <br /> SIGNING. <br /> In consideration for being permitted to engage in the following special event activities on City of <br /> Pequot Lakes property: <br /> /4,/) gebr, si'''' e. 71 .1r/'7L <br /> J U57 7/ /c- SLAT:A''/1-7 <br /> Special Events Holder hereby acknowledges,represents,and agrees as follows: <br /> A. We understand that the above described activities are or may be dangerous and do <br /> or may involve risks of injury, loss, or damage to us and/or third parties and we <br /> freely and voluntarily assume any and all such risks. We further acknowledge that <br /> such risks may include, but are not be limited to, bodily injury, personal injury, <br /> sickness, disease, death, and property loss or damage, arising from the following <br /> circumstances,among others: <br /> Special Events Holder Initials Here: <br /> B. If required by this paragraph, we agree to require each participant in our special <br /> event to execute a WAIVER, RELEASE AND INDEMNIFICATION <br /> AGREEMENT for the City of Pequot Lakes, on a form approved by the City. <br /> Participant Release and Indemnification required? YES 0 <br /> Special Events Holder Initials Here: <br /> S:\Administration\Licenses\Special Event Permits\Release Indemnification Agreement 12-28- <br /> 17.docx <br />