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Util <br />RELEASE FROM LIABILITY <br />Personal Information (Please print) <br />Full Name: Michael Ziobrowski <br />Address: 1001 n. french street, apt s <br />City: Santa ana <br />Emergency Contact: anemia Nolasco! 714,862.7894 <br />Social Security/Individual Tax Payer ID (ITIN) #: 625-03-1235 <br />Waiver and Liability Release <br />I have read and understand the Artists Agreement and will adhere to the rules E <br />forth wherein and act in a respectful manner while representing the City of Sant <br />the responsibility of mental and physical fitness to participate in the assignttteilt <br />by all rules and requirements of the program. I also understand that failure 'to a <br />may lead to my termination from the program. <br />I understand that I am not considered an employee of the City of Santa Ana for <br />Workers' Compensation, but that the City provides volunteer accident insurancE <br />other medical insurance I may have, I agree to comply with the City's policy re( <br />incur while under the City's supervision. <br />I agree to hold harmless the City of Santa Ana, its officers, employees and volui <br />against any and all liability arising out of or in any way connected with my panic <br />program. This release shall apply even though liability may arise out of negligei <br />on the part of those discharged including their employees, agents and volunteer <br />This waiver and liability release shall apply to myself, as well as any of my heirs <br />administrators. <br />I am of lawful age and legally competent to sign this agreement. I understand t <br />signed this document as my own free act.- <br />I have fully informed myself of the contents of this release by reading it before I' <br />that by signing this document I am giving up legal rights to which I may be entitli <br />M? _ (initial) I -have watched andu"nderstand the instructional and s <br />painting my artwork on thi <br />located on 302 N Main St, Santa <br />Title of artwork: Pastel Life <br />