Agreement: I, hereby, understand and agree to the following:
PARTICIPATION, MAINTENANCE AND USE
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This is a voluntary program and that I will not be provided with any compensation for my
participation in this program;
I grant access to the participating property to BSA Rain Check representatives to determine if
downspout(s) may be safely disconnected; install rain barrels, as practicable; and monitor
performance of barrels. All field crews will be properly identified and attempt to communicate
with the property owner prior to entering the property. At no time will a field crew personnel
need to enter the structure(s) (Ex. Home) on the property.
Rain Barrels are property of the Buffalo Sewer Authority and must remain at the property they
are installed;
I will maintain the barrel. This includes draining the barrel regularly, cleaning the screen
and/filter, inspecting the barrel for any cracks or damage, winterizing the barrel according to
provided instructions, and reconnecting the barrel each spring. Rain Check will provide
educational materials, as well as email reminders, to support barrel maintenance.
BSA Rain Check is not responsible for replacement of lost or damaged rain barrels.
If for any reason, I cannot fulfill the maintenance requirements, or no longer have a need for
the rain barrel, I must 1) direct the downspout runoff in accordance with City of Buffalo Building
Code requirements; and 2) contact the BSA Rain Check program at (716) 851-4664 X. 4254 to
make arrangements to return the barrel.
X_____________________________________________________________________ I agree
LIABILITY RELEASE
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To the fullest extent permitted by law, I hereby release the Buffalo Sewer Authority and City of
Buffalo, and their respective officers, agents, representatives and employees from all liability
and any damages that may result from my participation in the downspout disconnection/rain
barrel program.
X_____________________________________________________________________ I agree
Rain Check Buffalo
1038 City Hall
Buffalo, NY 14202-3378
T: 716-851-4664 x 4254
E: [email protected]
PHOTO RELEASE
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I hereby grant Rain Check and its partnering entities the right to use the photographs, videos
and/or voice recordings. These records become the property of Rain Check or its
representatives.
The records may be used for promotional or publicity purposes and may be published in mass
media publications. They may appear in connection with (a) the Rain Check website,
www.raincheck.ngrok.io; (b) publications for advertising, marketing, information and education,
or any other publication Rain Check may deem useful and appropriate, or (c) any electronic
and print media (i.e. television, social media, CD-ROM, video, pamphlets, mailings, etc.).
You hereby release Rain Check from claims and expenses arising from the use of your
materials as herein specified.
This release is given without promise of compensation.
This release is effective until terminated by a retraction in writing from the person granting this
authorization, or an immediate family member. Such revocation shall only be effective to
prevent any expanded future use of the records.
X____________________________________________________________ I agree (Optional)
Address: ________________________________________________________________
Name (Printed): __________________________________________________________
Phone Number:______________________E-mail:_______________________________
Signature: __________________________________________Date: ________________
Rain Barrel Color Preference (Green, Tan, Grey, Black): _________________________
Select only one: Do you need to be present during (Install) (Inspection) (Neither)?
Is there anything else we need to be aware of? Such as __Locked Gate __Dog __Other
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Rain Check Buffalo
1038 City Hall
Buffalo, NY 14202-3378
T: 716-851-4664 x 4254
E: [email protected]