HomeMy Public PortalAbout2015-07_Form_Wind Turbine Campsite RegistrationFire Permitted: ____ Yes ____ NoFor Office Use:
Campsite Permit #:_____________________
Approved Date: _______________________
Staff Signature: _______________________
Municipality of the District of Chester
Wind Turbine Campsite Registration Form
Name: ____________________________________________
Date of Birth: ______________________________________
Mailing Address:___________________________________
Home Phone: __________________________Cell Phone: ______________________________
Email: ___________________________________________________________
Number of campers in your group: ______________
Arrival Date:__________________________ Approximate Arrival Time: __________________
Departure Date: _______________________ Approximate Departure Time: _______________
Please note the following requirements related to your campsite permit:
Campsite permit holder must have their permit on site when camping.
Campsite permit is non-transferable.
Person making the reservation must be at least 19 years of age or older and must
accept responsibility for those under 19 years of age.
The campsite permit holder must be at the campsite dur ing the time of its use.
The campsite permit holder is responsible for the actions of all members of the
group.
Failure to adhere to campsite rules may result in cancellation of the permit.
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Signature Date
Please visit Dept.of Natural Resources for Fire Bands.
The website is updated daily at 2:00 pm.
http://novascotia.ca/natr/forestprotection/wildfire/burnsafe
Please Turn Over and Complete the Waiver Form
Municipality of the District of Chester: Wind Turbine Campsite
Assumption of Risk, Waiver of Claims, and Indemnity Agreement
Read this document thoroughly before you sign.
By signing this document you will waive certain legal rights including the right to sue or claim
compensation following an accident.
Assumption of Risk:
I understand that camping at the Municipality of the District of Chester Wind Turbine Campsite carries
with it certain risks, dangers and hazards including, but not limited to: exposure to wildlife such as bears,
uneven ground and walking area, close proximity to the fall zone of the wind turbine and that these risks,
dangers and hazards cannot be eliminated regardless of the care taken to avoid injuries, accidents or
illnesses (including death), and damage to property.
I understand and agree to adhere to any and all posted, written, verbal or otherwise expressed rules and
regulations and understand that the rules and regulations are designed for the safety and protection of
campsite users.
I freely accept and fully assume all such risks, dangers and hazards and the possibility of personal injury,
death, or property damage or loss resulting therefrom.
Waiver of Claims:
I do hereby release, waive, discharge, and covenant not to sue the Municipality of the District of Chester
or any of its officers, directors, employees, assigns or agents including volunteers, for any and all claims
including any claims arising from the negligence of the Municipality of the District of Chester resulting in
personal injury, accidents or illnesses (including death), and damage to property arising from, but not
limited to, camping at the Municipality of the District of Chester Wind Turbine Campsite.
Indemnification and Hold Harmless:
I further agree to indemnify and hold the Municipality of the District of Chester harmless from any and all
claims, actions, suits, procedures, costs, expenses, damages, and liabilities, including legal fees brought as
a result of camping at the Municipality of the District of Chester Wind Turbine Campsite, and to reimburse
them for any such expenses incurred.
I have carefully read the Assumption of Risk, Waiver of Claims, and Indemnity Agreement and
fully understand it and I am aware that by signing this agreement I am waiving certain legal
rights which I or my heirs, next of kin, executors, administrators, assigns and representatives
may have against the Municipality of the District of Chester.
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Name (Please Print)
__________________________________________________________________
Signature Witness Signature
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Date Date