Form Center

* indicates a required field

2. The County recognizes that funding for operating, and maintenance costs is limited for local Community Centres, Agricultural Societies, County Fire Departments and non-profit societies that operate a facility accessible to the public. It is the intention of the County to support these organizations through the Public Works Donations to Organizations Policy 32.1.13. 

   The below-mentioned organization hereby indemnifies the County against all actions, suits, claims and demands whatsoever by any person, firm, or corporation arising out of the resulting from services rendered as per County of Wetaskiwin No. 10. 

   Organizations may request up to the accumulation of $2,000 in value for goods or services. Requests exceeding $2,000 shall be brought to Council for consideration.

4. Name of the organization making the request:
6. Mailing Address:
8. City:
9. Province:
10. Postal Code:
12. Contacts Name:
14. Phone Number:
15. Email:
17. 
19. The above named organization hereby indemnifies the County against all actions, suits, claims and demands whatsoever by any person, firm or corporation arising out of or resulting from the County providing the above requested services.

    1. I agree.
21. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, and 2) by signing in this alternate manner, your electronic signature is valid and binding upon you to the same force and effect as a handwritten signature.

    1. I agree.
23. Electronic Signature
25. Protection of Privacy Act

    The personal information collected through this Public Works Donations to Organizations Waiver Form is for the purpose of managing organizations' requests for Public Works donations. This collection is authorized by Section 4(c) of the Protection of Privacy Act. For questions about the collection of personal information, please contact the County of Wetaskiwin Privacy Officer: email legislativeservices@county10.ca; telephone 780.352.3321.

    
    

Leave This Blank:


26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit