Bloomington Leadership Program Application

I understand that if selected for the Bloomington Leadership Program and alumni network, participation in the activity(ies) or program(s) is completely voluntary and that the activity(ies) or program(s) being offered is for the benefit of the participant(s). The City of Bloomington shall not be liable for any claims, injuries, or damages, of whatever nature, incurred by the participant(s) which are directly or indirectly attributable to the negligence, whether passive or active, of the City of Bloomington, their agents, or employees, arising out of, or in connection with the activity(ies) or programs. On behalf of the participant(s) and myself, I understand that I am waiving certain legal rights by agreeing to this Waiver and expressly agree to release and discharge the City of Bloomington, their agents, or employees, from any such claims, injuries, or damages. I also understand this waiver includes any injuries that may result from the condition of facility used in the activity or program.  

I understand that City staff may take video or photos of City sponsored activities. By signing this application, I waive any objection to the City sharing my name and/or my image in its promotional materials. If I wish to object the use of my image, then I will make my request known to the City of Bloomington in writing.