WAIVER/RELEASE FORM
I am aware that Halifax Water requires our customer of record or a designate to be present to have
water service reconnected. This prevents problems such as flooding due to internal plumbing problems
and open taps.
I, the undersigned, authorize Halifax Water to restore water service in my absence and release the
Halifax Regional Water Commission from any claims for any resulting damage.
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SERVICE LOCATION (Please Print)
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DATE (Please Print)
This form must be signed by either the homeowner, current customer of record or authorized party.
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Signature
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Print Name
Please indicate the authorized signature below:
□ Customer of Record
□ Homeowner
□ Authorized Party
This form can be returned to our office by Fax – 902-490-4749 or Email – [email protected]