Download To the fullest extent permitted by law, I do hereby agree to assume

Release and Indemnification
To the fullest extent permitted by law, ____________________________(name of
entity), of ____________________________________(address), do hereby agree to
assume all risk of injury, harm or damage to _____________(entity) or its property
(including but not limited to all injuries caused by the negligence of the Portland Water
District, its agents, officers or employees) arising during or in connection with use of a
water fountain supplied by the Portland Water District for use in conjunction with
_________________________________________(event) on ______________ (date).
__________________(entity) does hereby release and agree to indemnify and hold
harmless the Portland Water District, its agents, officers and employees from any and all
liability, actions, claims for attorneys’ fees damages and claims of any kind and nature
whatsoever, including but not limited to liability actions, damages and claims for
property damage and/or bodily injury, caused by or arising out of the acts of the Portland
Water District, its agents, officers or employees that may arise or occur in connection or
as a result of the use of the water fountain by _________________________(entity) as
described herein.
Dated_____________
___________________________________
Signature
___________________________________
Print Name and Title
Address____________________________
___________________________________
225 Douglass Street | Portland, ME 04102 | [P] 207.774.5961 | [F] 207.523.5440 | www.pwd.org