Pitt County Forms Center

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   3025 Landfill Road, Greenville, NC 27834  |  Telephone: (252) 902-3350

   PittCycle Fridays Claim Release Form
    

4. I, by participating in PittCycle Fridays and/or by signing this confirm, being an adult of at least 18 years of age, do agree that this is a contract with Pitt County (hereafter referred to as Donor) for the usage and acceptance of personal property donated by Donor through Donor’s PittCycle Friday program. I also have read and accept all PittCycle Friday participation guidelines and rules rules listed on the PITTCycle Fridays Website.

   In consideration for accepting the personal property from or through the Donor, the Recipient unconditionally RELEASES, WAIVES, DISCHARGES AND COVENANTS NOT TO SUE the Donor or the Donor’s officers, directors, employees, agents, or volunteers.

   The Recipient understands that this property has been previously used. The Recipient understands that this property has been discarded in a solid waste collection bin or receptacle at a Pitt County Solid Waste facility. The Recipient understands that Donor removed the property from a solid waste collection bin or receptacle, and Donor offered it for donation through its PittCycle Friday program. Recipient understands Donor has taken no steps to inquire about the status of property in any way. Recipient understands that Donor has taken no efforts to assess, clean, rehabilitate, refurbish, or repair the property.

   The Donor makes no representation regarding the history, condition, usefulness, or safety of the property. The Recipient is fully aware of the potential risks involved and potential hazards connected with using these items. The Recipient hereby elects to voluntarily accept the items with the full knowledge of these risks and hazards. The Recipient VOLUNTARILY ASSUMES FULL RESPONSIBILITY FOR ANY RISKS OF LOSS, PERSONAL INJURY, INCLUDING DEATH, that may be sustained by anyone who uses, encounters, or otherwise comes into contact with the property.

   DISCLAIMER OF WARRANTY: All personal property items are donated WITHOUT ANY WARRANTY, EITHER EXPRESSED OR IMPLIED, INCLUDING WITHOUT LIMITATION ANY WARRANTY OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE.

   I ACKNOWLEDGE AND REPRESENT THAT I have read, understand, and have fully informed myself of the contents. I acknowledge that I am signing this release willingly, voluntarily, and knowingly.

6. First & Last Name*
7. Email Address*
9. Address*
11. Phone Number*
13. Please give a full description of property accepted*
15. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
17. Electronic Signature*
18. Date*
20. Please upload a photo of your ID for verification.*
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