Event Request Form - Klein Volunteer Fire Department

Event Request

Contact Details

Please enter the Organization Name.

Please enter your name

Please enter a valid email address

Please enter your phone number.

Date & Time

Please enter the date of the event.

Beginning Time of Event

Please enter the beginning time of the event.

Ending Time of Event

Please enter the ending time of the event.

Location of Event
(provide address of event or station event will be held at)

Please enter the address.

Please enter the City and State.

Please enter the Zip Code.

Guest Details

Please enter the number of adults.

Please enter the number of children.

Please enter the age group of the children.

Request Details

Please enter your request.

Have any other organizations been invited? (EMS, police, etc.)

YesNo

Please make a selection.

If event is off site and not at a fire station, will there be enough room for the fire truck? (Approx. 75 ft.)

YesNo

Please make a selection.

Please enter any questions or comments.

RELEASE, INDEMNITY, AND HOLD HARMLESS AGREEMENT

This RELEASE, INDEMNITY, AND HOLD HARMLESS AGREEMENT (this “Agreement”) is made by and between Klein Fire Department and Emergency Services District No. 16 (collectively referred to as the “Department”) and the entity or organization named below (the “Custodian”):

1. The Custodian is requesting that a Department-owned fire apparatus (the “Truck”) be present at Custodian’s event (the “Event”). In consideration for the releases, covenants, promises, agreements, and acknowledgments described below, the Department will provide a Truck at the Event unless the Department needs the Truck to be in service elsewhere during the Event. The Custodian acknowledges this provision of the Truck for the Event as sufficient consideration for the Agreement below.
2. RELEASE OF LIABILITY AND INDEMNITY AGREEMENT:

2(a)
APPLICABILITY AND SCOPE OF RELEASES AND INDEMNITIES: For purposes of this Agreement, “Claims” shall mean any past, present, and future claims, losses, costs, expenses, liabilities, demands, penalties, fees, fines, or causes of action, and costs of defense or settlement (including, without limitation, attorneys’ fees and court costs), which arise from or relate to the Custodian’s custodianship of the Truck. The releases, waivers and indemnities contained in this Agreement expressly shall apply regardless of whether the Claims to be released, waived or indemnified against arise, or are alleged to arise, from (i) NEGLIGENCE (WHETHER SOLE, JOINT OR CONCURRENT), GROSS NEGLIGENCE, MALICE, NEGLIGENCE PER SE, BREACH OF CONTRACT, ACTIONS IN EQUITY, and/or STRICT LIABILITY, of the Department, its respective present and former officers, directors, subsidiaries, affiliates, employees, staff and agents (the “Released Parties”); (ii) personal injury, death or property damage; (iii) acts under the Texas Deceptive Trade Practices Act (“DTPA”); (iv) acts of any other persons or guests; (v) theft, burglary, assault, or other crimes; (vi) fire, water, wind, rain, lightning, and/or smoke and/or (vii) any other risks and hazards associated with the custodianship of the Truck.
2(b)
RELEASE FROM LIABILITY AND COVENANT NOT TO SUE: The Custodian hereby RELEASES, ACQUITS AND FOREVER DISCHARGES, and WAIVES any and all Claims against any of the Released Parties—including, but not limited to, the types of claims enumerated in Paragraph 2(a)—and agree not to sue any of the Released Parties for such Claims. Without limiting the foregoing, the Custodian agrees that the Released Parties shall not be liable to the Custodian, any persons present at the Event, and/or any other persons (including, but not limited to, employees, invitees, licensees, agents, guests, and minors) under Custodian’s care and control for personal injury, property damage, or any other Claims.
2(c)
AGREEMENT TO DEFEND, INDEMNIFY AND HOLD HARMLESS: THE CUSTODIAN AGREES TO DEFEND, INDEMNIFY and HOLD HARMLESS THE RELEASED PARTIES AGAINST (I) THE CONSEQUENCES OF THE RELEASED PARTIES’ OWN CULPABLE CONDUCT AND LIABILITY IN CONNECTION WITH THE EVENT, INCLUDING BUT NOT LIMITED TO NEGLIGENCE, GROSS NEGLIGENCE, STRICT LIABILITY, VIOLATIONS OF THE DTPA, PREMISES LIABILITY, PRODUCT LIABILITY, WILLFUL AND MALICIOUS CONDUCT, BREACH OF CONTRACT, AND ACTIONS IN EQUITY, IF ANY, REGARDLESS OF WHETHER SUCH CULPABLE CONDUCT WAS THE SOLE, PROXIMATE OR PRODUCING CAUSE OF THE CLAIMS, OR WHETHER SUCH CULPABLE CONDUCT WAS THE PROXIMATE OR PRODUCING CAUSE JOINTLY AND CONCURRENTLY WITH THE CULPABLE CONDUCT, IF ANY, OF THE CUSTODIAN, OR ANY OTHER INDIVIDUAL, ORGANIZATION, OR ENTITY; (II) THE CONSEQUENCES OF THE CUSTODIAN’S OWN CULPABLE CONDUCT AND LIABILITY IN CONNECTION WITH THE EVENT, IF ANY, REGARDLESS OF WHETHER SUCH CULPABLE CONDUCT WAS THE SOLE, PROXIMATE OR PRODUCING CAUSE OF THE CLAIMS; provided, however, that the duty of the Custodian to defend, indemnify and hold harmless the Released Parties shall extend only to Claims which may be asserted by the Custodian, any person present at the Event, and/or any other persons (including, but not limited to, employees, invitees, licensees, agents, guests, and minors) under Custodian’s care and control, including but not limited to any and all Claims by health care providers or facilities, estates and assigns of persons under Custodian’s care or care, and estates and assigns of persons present at the Event. As used herein, “INDEMNIFY” means to agree to assume the Released Parties’ liability in a situation, thereby relieving them of responsibility and/or reimbursing the Released Parties for Claims asserted against them.

Invalid Input

Custodian has read, understands, and agrees to the above. Custodian thoroughly and completely understands that this Agreement includes a complete and final release and indemnity agreement, that it is freely and voluntarily entering into this Agreement, and that no representations, promises, or statements made by any Released Party has influenced the Custodian in causing it to execute this Agreement. In addition, the Custodian Representative executing this Agreement represents and warrants to the Released Parties that he or she has the proper and sufficient authority to bind the Custodian to the terms and conditions of this Agreement.

Yes