Name______________________________________ (Please Print)
Address____________________________________
Telephone #_________________________________
Date_______________________________________
The undersigned agrees to hold the said Village and its employees and agents harmless from any liability and/or damages resulting from acts of said employees and agents in and about said premises.
The undersigned represent that they are the owners of said premises, have invited the Village of Evendale, Ohio, and its employees and agents upon the premises, and have the right to grant this release. This release shall be binding upon the undersigned, their heirs and assigns.
X__________________________________________
Signature
5/2012
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