MACON COUNTY CONSERVATION DISTRICT

3939 Nearing Lane, Decatur, Illinois, 62521 ● Phone: 217.423.7708 ● MaconCCD.org ● Rentals@MaconCCD.org

This agreement must be signed and submitted to secure your reservation. I agree to abide by all terms and conditions set forth in this document, and failure to adhere to these regulations will incur financial penalties and possible legal action.

For consideration of use of Macon County Conservation District properties for a special use event, I recognize and acknowledge that there may be certain risks of personal injury and property loss arising from the event and I agree to assume the full risk of injury, including death, loss, or damage of property from conducting the event. I agree to waive and relinquish all claims I may have as a result of hosting the event. I do hereby fully release and discharge the Macon County Conservation District and its Trustees, Directors, agents, servants, and employees from any and all claims from injuries, including death, damage, or loss which may occur to participants through activities of conducting the event. The Macon County Conservation District reserves the right to require certificate of insurance for any event that increases the District's liability. If required, the User shall provide a certificate of insurance verifying $1,000,000 minimum general liability insurance naming the Macon County Conservation District as an additional insured, accompanied by a properly executed additional insured endorsement using CG 2011 or equivalent, and specifying the date(s) and nature of the event no later than twenty-one (21) days prior to the event. If alcoholic beverages are being served or consumed, User must also provide proof of Dram Shop and Liquor Liability insurance. User's insurance shall be primary insurance as respects to the Macon County Conservation District. The District does not assume any liability for property damaged, lost, or stolen on District properties, or for personal injuries sustained on the premises during User's use of the premises and User hereby agrees to assume the full risk of any injuries, damages, or loss regardless of severity, that User may sustain as a result of this Agreement. User further agrees to waive and release the Macon County Conservation District from any and all losses, claims, suits, judgements, or damages that the User might sustain as a result of any and all activities connected or associated with this Agreement. I have read and fully understand the above details and Waiver and Release of all claims.

PRINT NAME OF RESPONSIBLE PARTY

SIGNATURE OF RESPONSIBLE PARTY

NAME OF ORGANIZATION (IF APPLICABLE)

OFFICE USE ONLY

PAYMENT RECEIVED DATE: ___ CASH $ ___ CHECK # ___ CC ___

ENTERED ONLINE: RECEIPT # ___ RESERVATION # ___ DATE ___

RECEIVED BY: ___

STAFF SIGNATURE: DATE:

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3939 Nearing Lane, Decatur, Illinois 62521 ● Phone: 217.423.7708 ● MaconCCD.org ● Rentals@MaconCCD.org

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