WASHINGTON COUNTY HISTORICAL SOCIETY

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SCARECROWS AND INDIANS

September 22, 2018

685 7th Street

Chipley Fl 32428

Chipley Farmers Market

VENDOR APPLICATION

Business/Organization Name__________________________________________________________________________

What do you

plan to sell? ______________________________________________________________________

Vendors are responsible for removal of their own trash items.

Contact Name____________________________________________________________________

Mailing Address___________________________________________________________________

City______________________________________________________ST_________ZIP________

Phone__________________________________________________________________________

Day Evening

Email___________________________________________________________________________

$10 Vendor Fee is Due immediately and can be mailed to:

Washington County Historical Society

685 7th Street

Chipley Fl 32428

For more information, please call Dorothy Odom at 850) 638-0358




I, _______________________________, hereby affirm that I have been well advised and thoroughly informed of the inherent hazards and policies of the event. I know that by participating in The Chipley Garden Club &Washington County Historical Society Scarecrow Festival, I am exposing myself to certain known and unknown liabilities in my direct and indirect interactions with the public and invitees of this event. I also understand that if I choose to hire help for the event, that I am directly responsible for their actions or injury. I hereby personally assume all risks associated with my voluntary participation in this event of any harm, injury or damage that may befall me or any employee or temporary help, as a result of my participation, whether foreseen or unforeseen.

I understand and agree that neither Chipley Garden Club, Washington County Historical Society and the City of Chipley, FL, its Board or Council may be held liable in any way for any occurrence in connection with my participation in the Scarecrow Festival that may result in injury, death, or other damages to me or my family, heirs, or assigns, and in consideration of being allowed to participate in this event, I hereby personally assume all risks in connection with said event for any harm, injury, or damage that may befall me, including all risks connected therewith, whether foreseen or unforeseen; and further to save and hold harmless said event and persons from any claim by me, or my family, estate, heirs, or assigns arising out of my participation in this event.

I further state that I am of lawful age and legally competent to sign this affirmation and release, or that I have acquired the written consent of my parents or guardians; that I understand the terms herein are contractual and not a mere recital; and that I have signed this document of my own free will.

It is my intention by this instrument affirmed by my signature below to exempt and release Chipley Garden Club, Washington County Historical Society and the City of Chipley, its Board and Council members, from all liability whatsoever for personal injury, employer’s liability and workers’ compensation, property damage of wrongful death arising out of or in the course of my participation in this event.

I HAVE FULLY INFORMED MYSELF OF THE CONTENTS OF THIS AFFIRMATION AND LIABILITY RELEASE BY READING IT BEFORE I SIGN IT.

Signature __________________________________________________________ Date _________________

Name (please print or type)__________________________________________________________________

Business Name___________________________________________________________________________

Address_________________________________________________________________________________

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