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ADOPT A HIGHWAY
ONLINE SAFETY TRAINING SEMINAR
INDIVIDUAL PARTICIPATION FORM
VIEW THE VIDEO BELOW AND THEN COMPLETE THE FORM BELOW THE VIDEO
AAH Individual Safety Certification
Name of AAH Group
Participant Name, if minor add Parent/Guardian (*)
I/We understand that participation in the Adopt a Highway Program involves standing and walking near a state highway while traffic is present and is a potentially hazardous activity. I/We assume all risks associated with participation in the program and hereby for myself, - my heirs, executors and administrators waive and release the State of New Jersey, New Jersey Department of Transportation, its Commissioner, officers and employees from all claims, liability, risk of loss and damages of any kind including wrongful death associated with or arising out of my/our participation in the Adopt A Highway Program. I/We certify that I/We have reviewed and understand that Adopt a Highway safety materials prior to my participation in the Program.
IF SIGNATORY IS LESS THAN 18 YEARS OF AGE, THIS MUST ALSO BE SIGNED BY A PARENT OR GUARDIAN. NO VOLUNTEERS UNDER 16 YEARS OF AGE.
You must view the video AND then check this box to affirm you have watched it before clicking on the Submit Certification button below.
I am not a Robot
Last Updated: 12 June 2018
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