Pelham, NY · Westchester County
Waiver and Release of Liability
This agreement releases the Village of Pelham from liability for work or other activities and is completed by an individual or designated representative.
What this form is
The waiver is for use in connection with work or other activities conducted at a location identified on the document. It asks for the activity and location, the signer’s name and address, and the name and address of any represented organization. The signer agrees to release and indemnify the Village of Pelham and signs and dates the document; a witness also signs and dates it.
Who needs it
An individual or an authorized representative completing a waiver in connection with work or other activities conducted at a stated location may use this agreement.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This document is signed without a notary; the signer and a witness each sign and date it.
How to submit this form
- 1
Download The Waiver
Download the Waiver and Release of Liability PDF.
- 2
Complete The Details
Enter the activity and location, then provide the signer’s name and address and, if applicable, the represented organization’s name and address.
- 3
Sign And Date
The signer and a witness each sign and date the document.
- 4
Submit To The City
Submit it to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- What does the Waiver and Release of Liability cover?
- It releases the Village of Pelham from liability for claims related to work or other activities identified on the document and includes an indemnity agreement.
- Who completes this waiver?
- An individual, or a duly designated representative acting for an organization, provides identifying details and signs the document.
- Do I need a notary for the Waiver and Release of Liability?
- No. This document has no notary block; the signer and a witness sign and date it.
- How do I submit the Waiver and Release of Liability?
- The document does not give submission instructions. Submit it to the city department named on the form; check the city website for current contact details.
Need something notarized?
This Waiver and Release of Liability doesn’t need a notary — but if you have another Pelham form that does, a commissioned online notary can help.