Permission to Enter and Hold Blameless Form

Snowplowing/Grading Private Driveways

I, ___________________________________ of _________________________ in consideration of the benefits accruing to me as owner or lessee of the land hereinafter described, hereby grant permission to the Council of the Municipal District of Wainwright No. 61, its agents and/or its employees to enter with the necessary equipment, machinery onto the said land namely:


for the purpose of :


By signing this form, the Municipal District of Wainwright does not in anyway obligate itself to conduct snow removal on private driveways. The M.D. will make reasonable attempts to clear private driveways as time allows at no charge. Local roads are a priority. Those in need of immediate snow removal should make arrangements with a private contractor or use their own resources.

I also hereby agree to hold harmless and indemnify the Council of the Municipal District of Wainwright No. 61, its councillors, employees and/or its agents, from and against all actions, suits, claims and demands arising from the operation and/or use of the said equipment, and/or machinery, on the said land, excepting any damage, or costs arising from the negligence or intentional acts of the councillors, employees and/or its agents.

This personal information is being collected under the authority of Section 33C of Freedom of Information and Protection of Privacy Act, and will be used for public works purposes. If you have any questions about the collection contact the Municipal Administrator or Assistant Municipal Administrator at 780-842-4454.

Date this ____ day of _________________________, A.D. 20______.

Witness   Signature of Owner
    Signature of Lessee
    Director of Transportation

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