Travel and Participation Permission Form

I understand that participation in the 2022 Point In Time (PIT) Count with the City of Durham’s Community Development Department involves risk of injury or illness. These risks include, but are not limited to, inclement weather, accidents while traveling, risks associated with transportation by motor vehicle, food related illness, equipment problems or failures, contact with and actions of other participants, spectators, and volunteers, slips/trips/falls, and musculoskeletal injuries, among others. I choose for myself to participate in the 2022 PIT Count despite the risks. By signing this Travel and Participation Form, I acknowledge all risks of injury, illness, death, and property damage, and affirm that I have assumed all responsibility of injury, illness, or death in any way connected with participation in the PIT Count. I also agree for myself and for any minor participant to follow all rules and procedures of the program and to follow the reasonable instructions of Community Development staff organizing this project. By signing below, I understand that I represent to the City of Durham and Durham County Continuum of Care that I am over the age of 18. I hereby agree to hold harmless and release the Durham Continuum of Care; its member organizations, their boards/trustees, employees, volunteers, count organizers; and other participants in the Durham Point-In-Time Count 2022 from any theft or loss of property arising from the participation as a Volunteer in the Point-In-Time Count, regardless of whether incurred as a result of negligence or other. I voluntarily assume these and any other risks for myself in participating in the count and waive all claims and causes of action that may arise out of participation in the count.

In return for the opportunity to participate in this project, I agree for myself and for my heirs, assigns, executors, and administrators to release, waive, and discharge any legal rights I may have to seek payment or relief of any kind from the City of Durham, its employees or its agents for injury, illness, or death resulting from this project. I also agree not to sue the City of Durham, its employees, or its agents and agree to indemnify the City of Durham for all claims, damages, losses, or expenses, including attorney’s fees, if a suit is filed concerning an injury, illness, or death to me or to my child resulting from participation in the 2022 PIT Count .

By typing your name into this box, you indicate consent that this serves as your signature