2. First Name*
3. Last Name*
5. Street Address*
6. Zip Code*
8. Ward*
   -- Select One --Ward 1Ward 2Ward 3Ward 4Ward 5Ward 6Ward 7Ward 8Ward 9Ward 10
9. Don't know your ward?

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11. Email Address (if applicable)
12. Phone Number*
14. How many homes are you willing to commit to shovel per snow event?
    -- Select One --1234
15. Do you have a shovel or a snow blower?*
    -- Select One --YesNo
19. No Harmless Statements for Registration Forms

    By submitting this form, I agree and acknowledge that 1) my application will not be signed in the sense of a traditional paper document, 2) this will be valid and binding upon me to the same force and effect as a handwritten signature, and 3) volunteer acknowledges that participation in this program involves shoveling snow, which may be heavy, and other related strenuous and physical activity related to snow shoveling, including, but not limited to: walking, bending, squatting, and lifting, and often in cold temperatures and for prolonged periods of time. Volunteer acknowledges that he or she is in the physical condition to participate in this program, and has no medical conditions or diagnoses which would prohibit or affect the ability to participate in snow shoveling safely. Volunteer assumes the risk of such activity and agrees to release and hold the COA and its elected officials, officers, employees, and agents harmless from any claims associated with participating in this program.

23. Electronic Signature Agreement*

    I hereby acknowledge and agree that my participation in the City of Aurora’s (“the City”) senior shovel program is entirely voluntary. I understand that by participating in this program, I am consenting to volunteers or contractors coming to my residence for the purpose of shoveling snow from my sidewalk and/or driveway without charge.  I understand that the snow shoveling volunteers or contractors are not employees of the City and are not being supervised by the City. I further understand that the City does not in any way warrant, guarantee, or monitor the efficiency or work product of the snow shoveling volunteers or contractors. I further understand that the volunteers or contractors are coming to my residence for the sole purpose of shoveling the exterior of my home and should not be allowed inside my residence for any reason. In exchange for these shoveling services, I hereby agree to release and hold harmless the City of Aurora, its elected officials, employees and agents, from any and all claims, causes of action, demands, lawsuits, costs, expenses, and liability for damages to persons or property, that may be asserted or claimed as a result of the City’s Senior Snow Shovel Program.

    1. I agree.
25. Electronic Signature
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27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit Submit and Print

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