Blue Bishop Community Outreach Day


Blue Bishop Community Outreach Day!
Westside Citizens United
P.O. Box 536
Asbury Park, NJ 07712
Resource Table Request

Organization Name: _______________________________________________________

Organization Type: ________________________________________________________

Contact Information: _______________________________________________________

Address: _________________________________________________________________


Contact #: _______________________________________________________________

Contact email: ____________________________________________________________

 Type of Items to be Offered/Displayed: ________________________________________


Number of Tables setting up ___________                                  Chairs _____________

Gift Contribution __________________________________________________________
            Example: cases of Gatorade or a case of school supplies (notebooks, pencils, etc)

Stop at the table on the corner of Springwood Avenue & Atkins Avenue, for checking in please bring your business card & contribution to the check in table.

Waiver of Liability Agreement

Name ___________________________________ Title _____________________

Signature ______________________________________________ Date _______


In consideration of the risk of injury while participating in Westside Citizens United’s 1st Annual Blue Bishop Community Outreach Day(the "Activity"), and as consideration for the right to participate in the Activity, I hereby, for myself, my heirs, executors, administrators, assigns, or personal representatives, knowingly and voluntarily enter into this waiver and release of liability and hereby waive any and all rights, claims or causes of action of any kind whatsoever arising out of my participation in the Activity, and do hereby release and forever discharge Westside Citizens United, located at P.O. Box 536, Asbury Park, NJ 07712, their affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and assigns, for any physical or psychological injury, including but not limited to illness, paralysis, death, damages, economical or emotional loss, that I may suffer as a direct result of my participation in the aforementioned Activity, including traveling to and from an event related to this Activity.

I am voluntarily participating in the aforementioned activity and I am participating in the activity entirely at my own risk.  I am aware of the risks associated with traveling to and from as well as participating in the WCU 1st Annual Blue Bishop Community Outreach Day, WHICH MAY INCLUDE, BUT ARE NOT LIMITED TO, PHYSICAL OR PSYCHOLOGICAL INJURY, PAIN, SUFFERING, ILLNESS, DISFIGUREMENT, TEMPORARY OR PERMANENT DISABILITY (INCLUDING PARALYSIS), ECONOMIC OR EMOTIONAL LOSS, AND DEATH. I understand that these injuries or outcomes may arise from my own or others negligence, conditions related to travel or the condition of the activity location.  Nonetheless, I assume all related risks, both known or unknown to me, of my participation in this activity, including travel to, from and during the activity.

I agree to indemnify and hold harmless Westside Citizens United against any and all claims, suits or actions of any kind whatsoever for liability, damages, compensation or otherwise brought by me or anyone on my behalf, including attorney's fees and any related costs, if litigation arises pursuant to any claims made by me or by anyone else acting on my behalf. If Westside Citizens United incurs any of these types of expenses, I agree to reimburse Westside Citizens United.

I acknowledge that and their directors, officers, volunteers, representatives and agents are not responsible for errors, omissions, acts or failures to act of any party or entity conducting a specific event or activity on behalf of Westside Citizens United.

 I acknowledge that I have carefully read this “Waiver and Release” and fully understand that it is a release of liability.  I expressly agree to release and Westside Citizens United and all of its affiliates, managers, members, agents, attorneys, staff, volunteers, representatives, predecessors, successors and assigns, from any and all claims or causes of action and I agree to voluntarily give up or waive any right that I otherwise have to bring a legal action against Westside Citizens United for personal injury or property damage.

To the extent that statute or case law does not prohibit releases for negligence, this release is also for negligence on the part of Westside Citizens United, its agents, and employees.  In the event that I should require medical care or treatment, I agree to be financially responsible for any costs incurred as a result of such treatment. I am aware and understand that I should carry my own health insurance.

In the event that any damage to equipment or facilities occurs as a result of my or my family's willful actions, neglect or recklessness, I acknowledge and agree to be held liable for any and all costs associated with any actions of neglect or recklessness.

Terms and Conditions

  • Reservations are made on a space availability basis, and are first-come, first-served. We reserve the right to place each provider’s display space at our discretion.
  • Hours for set up will start at 9am. All providers setup needs to be completed by 11:30am, event will start 12 noon (promptly).
  • Event will be held on August 19, 2017 from 12noon - 4:00PM
  • All service providers must supply their own table & chairs(no more than two chairs per table)
  • Offering/displaying of items or services is to take place in designated spaces only
  • Space size varies by location, but is approximately 8'x8'
  • All providers must comply with Westside Citizens United (WCU) & the City of Asbury Parks policies and procedures.
  • Service Providers services provided must conform to all applicable local, state, and federal laws and/or regulations.
  • Vendors are responsible for removal of any setups and/or material at the end
  • Electrical outlets will not be available. No extension cords are provided
  • It is important that each organization/agency hosting a table is asked to donate a case of water and/or giveaways (school supplies) during the event.
  • The Waiver of Liability must be submitted with Resource Table Request

The deadline for your organization to submit paperwork in order to participate in the August 19, 2017 event will be June 23, 2017.  Paperwork can be mailed in or emailed to
            Paperwork to be submitted:
  • Resource Table Request/Waiver of Liability

Thank you for your continued support.

Ms. Nina Marie Ida Summerlin
President of the Westside Citizens United
P. O. Box 536
Asbury Park, NJ 07712