Section 1 of 1 in this document

Firewood Removal Permit Application

Applicant

Name

Address

Date of Birth

Hold Harmless Agreement

The below-signed person understands and acknowledges that the City of Pocatello, a municipal corporation, is making available for removal, on a no cost permit basis, firewood from felled trees located on City of Pocatello property.
 
The below-signed person is aware and understands that the cutting, loading, and hauling of firewood are potentially dangerous activities with the potential for death, serious injury, and property loss or damage.  These risks include, but are not limited to, hazards of injury to my person or property while engaged in the cutting, loading, and hauling of firewood.
 
The below-signed person is aware and understands the risks of personal injury, accidents and/or illness, include but are not limited to sprains, strains, torn muscles, and/or ligaments; fractured or broken bones; eye damage; cuts, wounds, scrapes, abrasions and/or contusions; dehydration and/or oxygen shortage; cardiac arrest; head, neck and spinal injuries; shock; paralysis or death; and serious injury or impairment to other aspects of his/her body and general health and well-being.
 
The below-signed person, for him/herself, his/her heirs, representatives, successors, and assigns, in consideration of this permit to remove firewood from City of Pocatello property, covenants with the City of Pocatello and its successors, representatives and assigns, as follows:
 
  1. The below-signed person covenants to save, defend, hold harmless and indemnify the City of Pocatello, and all of its agents and employees (collectively “the City”) from and against any and all claims, loss, damage, injury, cost (including court costs and attorney’s fees), charge, liability, or exposure, however caused, resulting from, arising out of, or in any way connected with the cutting, removal, loading, and/or transportation of firewood on or from property of the City of Pocatello by the below-signed person.
  2. In executing this Firewood Removal Permit and Hold Harmless Agreement, the below-signed person represents and warrants that he/she has completely read, fully understood, and voluntarily accepted its terms and has executed it expressly to make the covenants in favor of the City described above.  In executing this agreement, the below-signed person further represents that he/she is at least eighteen (18) years of age.

Age Certification

Assumption of Risk

Signature

Signature
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