Senior Center Resource Fair Application

Today's Date *

Entry Title *

Organization/Business Name *

Contact Name *

First

Last

Phone Number *

Email Address *

Business Address *

City *

Zip *

Description of Organizations and Services offered: *

Non-Profit

Check here if organization is a Non-Profit

If your organization is a Non-Profit, please upload a copy of the Non-Profit status below:

Please upload a copy of Non-Profit status here.

Click or drag a file to this area to upload.

Terms of Agreement - Please check each of the following boxes and sign below to acknowledge agreement to these terms: *

I understand that submission of this application does not guarantee my participation and that all applications will undergo review.
I understand that I must arrive by 10:00am to set up and that I will not be given a refund due to late arrival.
I understand that all organizations must be prepared and open for business at or before 11:00am
I understand that I may not breakdown or cleanup my space until the end of the event at 1:30pm.
I understand that this event is solely for informational purposes and that I and/or my organization may not solicit any sales of any products or services during this event.
I understand that to receive a non-profit rate I must submit proof of my organization’s Non-Profit status (Non-Profit organizations only)
ASSUMPTION OF RISK, RELEASE, HOLD HARMLESS, AND CONSENT TO MEDICAL TREATMENT AND PHOTOS:
On behalf of myself and my organization, I acknowledge my participation in the event, but that accidents and injuries can arise from such participation. Knowing these risks and in consideration of acceptance of my application, I voluntarily desire to participate in this event and assume all risks and waive and release City and its officers, employees and agents from any claims or liability for personal injury (including death) or property damage arising from or connected with participation in the activity, even if the liability may arise out of negligence or carelessness of the City of its officers, employees and agents, who through negligence or carelessness might otherwise be liable to me (or my heirs or assigns). In the event of injury or illness, I consent to and agree to be responsible for costs for transportation to a medical facility and whatever examination, procedure or treatment considered necessary by the medical personnel. The assumption of risk, release and hold harmless is binding on my heirs, dependents, executors, administrators, and assigns. I agree to abide by any rules and regulations for the activity. I give consent to the City of Antioch to photograph or video the participant for any legitimate purpose by the City or sponsors of this activity.

Name