Schedule 'B' - Plot Agreement and Release Form
Legal waiver and agreement form for garden plot holders.
Town of View Royal 45 View Royal Ave P149 Victoria BC Canada V9A 1A6 T: 250.708.2258 F: 250.727.9551 www.tvr.bc.ca
Schedule "B"
View Royal Park Community Gardens - Plot Agreement and Release
| Last Name: | Given Name(s): |
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| Address: | City: |
| Home Phone Number ( ) |
Work Phone Number ( ) |
| Date of Birth (for insurance purposes): | Email Address: |
In case of Emergency notify:
| Last Name: | First Name: | Relationship: |
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| Address: | City: | Postal Code: |
| Home Phone Number ( ) |
Work Phone Number ( ) |
Cell Phone Number ( ) |
| Allergies: | Medications/Medi-alert needs: |
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| How did you find out about the Community Gardens? |
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In consideration of the Town of View Royal granting the use of one Garden Plot, located in View Royal Park, 1300 Pheasant Lane, Victoria, BC, for a three year term, I have read, understand and hereby agree to abide by the general guidelines governing the use of the Garden Plots as stated in the attached Schedule A "Terms and Conditions" and to pay all fees in full as stated below upon registration.
I, (name) ________________________________________ state that I am at least nineteen years old and the information provided above is true and correct. I agree that I will use the premises in "as is" condition, and will be solely responsible for my presence there accordingly. I agree that my use of the premises is at my sole risk.
In consideration for being permitted to participate in the "Community Garden" program, I hereby release, discharge, indemnify and hold the Town of View Royal, harmless from all injuries to any person(s), including death, personal injuries, damages to property, loss of time, and/or any and all other loss or damages, whether caused or occasioned by the negligence of the Town of View Royal, its employees or servants, or any other person whatsoever, arising or flowing from the use, operation, or participation in the program, accepting to and for myself the full responsibility for any and all such damage, injury or death. I agree that this Agreement and Release shall be governed by the laws of the Province of British Columbia and is intended to be as broad and inclusive as permitted by such laws. By executing this Agreement and Release on the above noted date, I agree to be legally bound by all terms of this Agreement and Release which I have read and understand
I further understand that I am responsible for the safety and security of all my property and possessions at the Community Gardens at all times.
Annual Garden Plot Usage Fee: $ __________
Commencement Date: ____________________ Expiry Date: ____________________
Signature of Gardener: ________________________________________ Date: ____________________
Photo waiver
P150
The Town of View Royal has my permission to use any photographs, film, or other images taken of me participating in this Community Gardens program. I understand my photograph/image may be used in brochures, newsletters, fact sheets, news articles, posters, audio/visual materials, on the Town of View Royal website, or in other printed materials.
Signature: ________________________________________ Date: ____________________
[ ] I decline to have my image used.
FREEDOM OF INFORMATION WAIVER
Personal information contained on this form is collected under the authority of the Local Government Act and is subject to the Freedom of Information and Protection of Privacy Act. The personal information will be used for purposes associated with the Community Gardens program. Enquiries about the collection or use of information in this form can be directed to the Freedom of Information and Protection of Privacy contact: Town of View Royal, Coordinator, FOI (250) 479-6800
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