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2. Use or Activity Requested*

   Please list the event or activity that you are completing this form for (e.g., shelter use, park use, etc.).

4. Location Requested for Use*
6. Name of Person or Company (the "Undersigned")*
8. WHEREAS, the Undersigned has asked to use property or facilities belonging to or under the auspices of the City of Frankfort, Kentucky (the "City"), for the uses described above; and WHEREAS, the Undersigned agrees to do so at their own risk and recognizes the possible and inherent danger to their person or property and the person and property of others resulting therefrom; and WHEREAS, in consideration of allowing the Undersigned to conduct its activities on the City property, the City requires that the Undersigned accept liability for any damages arising from personal injury or property damage sustained from the activities of the Undersigned, which shall include action or inaction of the Undersigned, and that the Undersigned indemnify the City from any claims associated with said damages. NOW, THEREFORE, in consideration of the mutual promises contained in this Agreement and for other good and valuable consideration that the parties agree they have received, the Undersigned does hereby for themselves, their heirs, executors, employers, successors or administrators, and their personal representatives: 1) Assume full responsibility for any personal injury or any damage to their personal property which may occur, directly or indirectly, while in, on, or about any City premises or parts thereof; 2) Fully and forever release and discharge the City, its elected officials, its agents and employees, from any and all claims, demands, damages, rights of action, or causes of action, present or future, whether the same be known, anticipated, or unanticipated, relating to, resulting from, or arising out of the Undersigned being in, on, or about or using any such City property, or at any or all of the premises or places aforesaid; 3) Indemnify and hold harmless the City, its elected officials, its agents and employees, for any act, activity, use or conduct of the Undersigned of whatever kind or nature whatsoever, while in, or about any such City property, or at any or all of the premises and places aforesaid; 4) Agree to defend the City in and to pay any attorneys' fees as a result of any action brought by or against the City, its agents and employees, for any acts, activity, use or conduct of the Undersigned of whatever kind or nature whatsoever, while in, on, or about or using any such City property, or at any or all of the premises aforesaid; 5) Agree that it is the intent of the Undersigned that this Release and Indemnity Agreement shall be in full force and effect any time after the Execution hereof until the Undersigned provides the City written notice of cancellation and the City provides the Undersigned written notice that the City received the cancellation.
10. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
12. Electronic Signature
13. Date
    Date

    Date
15. First Name
16. Last Name
18. Address
20. City
21. State
22. Zip Code
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24. 1. Receive an email copy of this form.
25. Email address

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26. Submit

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