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2024 Needham Community Beds Standalone Waiver Form

Welcome to Needham Community Beds Waiver & Relase Form!

Any Person 18 Years old or older who plans to garden at the Community Beds MUST fill out this Form Themselves!

Please Note: This is NOT a Registration Form for the Community Beds. If you are filling out this form, then you or someone in your household should be registered to use a Needham Community Farm Community Bed this year.

Name *

First Name

Last Name

Spouse or Partner Name

Note that all adults coming to the Farm will need to fill out their own Waiver.

Household Address *

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Phone *

Email *

Verify Email *

Join the Needham Community Farm Email List? *

I would like to subscribe to the Needham Community Farm email list, for monthly Newsletter and other notifications.

Yes - Add me to the List!

Yes - I'm already on the List, keep me on!

No - Do not add me to the List

Photo Release, and Electronic Signature

Picture Release *

Needham Community Farm occasionally uses pictures and videos of volunteers and program participants on the Farm website and in printed material, videos, social media, and picture displays. Please read the following and choose an option.

I hereby grant Needham Community Farm the right and permission to use pictures/videos in which the above named Family Members may be included, in conjunction with Needham Community Farm activities in photographs, videos, online, and printed material.

I hereby state that I do NOT grant permission to use pictures/videos of the above named Family Members as stated above.

By entering your name and today's date below, you are submitting an electronic signature for this consent form, release from indemnity, and the option you have selected above for the photo and video release.

CONSENT FORM, RELEASE FROM LIABILITY & INDEMNITY AGREEMENT

THE UNDERSIGNED, in consideration of the Needham Community Farm, Inc. allowing my use of the of a community gardening bed located at the Needham Community Farm, 145 Pine Street, Needham, Massachusetts for community garden purposes agree as follows:

I, my heirs, personal representatives, next of kin, estate, administrators and assignees (the “Releasors”) hereby certify that I have full knowledge of the nature and extent of risks inherent in my use of the community garden and assigned community garden bed and I understand that I will be solely responsible for any loss or damage, including death, which any person may sustain or cause, to any myself, to any of my property or any other person or property as the result of my activities. By this agreement, Releasor/Gardener is relieving the Town of Needham, owner of the Premises, Needham Community Farm, and all of their employees, agents, and board members (the “Releasees”) of any and all liability for such loss or damage.

The Releasor/Gardener agrees to forever release the Releasees from any and all claims, rights of action and causes of action that may have arisen in the past, or may arise in the future, directly or indirectly, from my use of the Premises. The Releasor/Gardener also promise to indemnify, defend, and hold harmless the Releasees against any and all legal claims and proceedings of any description that may have been asserted in the past, or may be asserted in the future, directly or indirectly arising from (a) personal injuries to myself or to other person(s); or (b) real or personal property damage resulting from my use of the Garden.

The names of family members under age 18 who whill be coming to the NCF Community Beds are covered by this form are listed below.

I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE AND WAIVER OF LIABILITY AND A LEGALLY BINDING CONTRACT OF INDEMNITY GOVERNED BY MASSACHUSETTS LAW. I CERTIFIES THAT I AM 18 YEARS OF AGE OR OLDER, AM LEGALLY COMPETENT TO SIGN THIS AGREEMENT, AND HAVE SIGNED IT OF MY OWN FREE WILL AS A DOCUMENT UNDER SEAL.

Names of Family Members under age 18 who will be coming to the NCF Community Beds and covered by this Waiver are listed below.

Please include first and last names of each minor child, separated by commas.

Electronic Signature *

Please E-Sign with Full Name

Date of Signing *

(mm/dd/yyyy)