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2. Event Date
   Event Date
3. Event Location
5. First Name
6. Last Name
8. Address
10. City
11. State
12. Zip Code
14. Will a minor child participate?

    1. YES
15. If YES, print out form, sign and bring to event or fill out, sign and upload.
17. Download Child Headstone Cleaning Program Form (PDF)
19. Child Name
21. Parent/Guardian Name
23. Emergency Contact if different than Parent/Guardian
25. IMPORTANT: Photographs will be taken at this event. If you do not wish to have your photograph taken, initial below.
27. I do NOT give permission to use any photos of myself taken during this program for publicity or program literature:
28. Initial here:
30. I understand that participation in the Hunterdon County Headstone Cleaning Program involves activities which pose a potential risk of personal injury. Some examples of these activities include handling sharp or heavy trash, chemicals and cleaning solutions; working outdoors in weather that can turn unexpectedly hot, cold, windy, or stormy; and walking on surfaces which can conceal sharp or hazardous objects.
32. I assume all risks associated with participation in the program and hereby for myself, my heirs, executors and administrators waive and release The County of Hunterdon its governing body, officers and employees, from all claims, liability, risk of loss or injury and damages of any kind including wrongful death associated with or arising out of my participation in the proposed program work.
34. I certify that I have reviewed and understand the Safety Guidelines. I understand that while those materials contain instructions intended to protect me from injury, even my full compliance with those instructions will not guarantee that no injury will occur.
Leave This Blank:


38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit

* indicates a required field