I hereby authorize the City of Dickson to install a stationary 911 marker at the residence listed below. I understand and agree that the City of Dickson is providing a free public service in the interest of encouraging fire / life safety and helping prevent needless injury and / or loss of life and property. I understand that the City of Dickson is not the seller, manufacturer or dealer in the yard marker and makes no warranties, express or implied with regard to this product. The user accepts the marker in present condition "as is". In exchange for accepting installation, I agree not to make any claim or demand or to file any lawsuit against the City of Dickson, or any individual who is involved in the SECONDS MATTER campaign, for any injuries, deaths, damages, costs or expenses claimed to have resulted from installation, maintenance, and safety given at the time of installation of the marker.
I hereby waive any cause of action that I may have now or in the future or that anyone else may have by or through me should I move location or sell the property mentioned below. I further agree to indemnify and hold harmless the City of Dickson, its employees, agents, and assigns as to any such claim that may be brought by other parties. For the marker to be effective, I understand and have agreed that the marker will need to be maintained on a regular basis. I agree to make sure it is visible and reabable from its properly installed location.
This release from liability is binding on me and my family and all my heirs, successors and assigns.
BY SIGNING BELOW, I ACKNOWLEDGE RECEIPT OF THIS 911 MARKER AS A GIFT FROM THE CITY OF DICKSON AND AGREE TO TAKE FULL RESPONSIBILITY FROM THIS DATE FORWARD.