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2. 
3. Cranberry Township Customer Service
   2525 Rochester Rd., Cranberry Township, PA 16066
   Ph: 724-776-4806
   Hours: Mon.-Fri., 7:30 AM - 5:00 PM
   
5. If you need assistance or wish to volunteer to help others during the COVID-19 Pandemic, use this form. Please provide as much detail as possible and allow us to better serve you as a resident in the Cranberry area.
7. Name:*
8. What is the best way to contact you?

   1. Email
   2. Phone
10. E-Mail Address:
11. Phone Number:
13. Address:*
15. If you need assistance, please describe your immediate needs: (groceries, prescription pickup...)
16. If you wish to volunteer, please describe the services you can provide.
18. In consideration of my being permitted to participate as a Volunteer or Recipient in the Cranberry Township Community Response Team Program (the “Program”), I, on behalf of myself and any of my personal representatives, heirs, and next of kin, hereby COVENANT NOT TO SUE and to HOLD HARMLESS, RELEASE, AND INDEMNIFY Cranberry Township, its officers, agents and/or employees (hereinafter referred to as the “Releasees”) from any and all liability, claims, demands, actions and causes of action whatsoever, brought by any party against any party, arising out of my participation in the Program and whether caused by the negligence of the Releasees or otherwise. This RELEASE, WAIVER OF LIABILITY and INDEMNIFICATION AGREEMENT shall remain valid in perpetuity and shall include all possible claims of negligence or other causes of action that could be asserted against the Releasees by me. I warrant and represent that I understand and accept the conditions of my participation as a Volunteer or Recipient in the Cranberry Township Community Response Team Program, having full authority to do so. I recognize that my participation in the Program shall not include any interactions or communications with recipient owner(s) of private property except to the extent necessary to perform requested tasks. I further recognize that no entry inside the requestor’s residence(s) is permitted in conjunction with my participation in the Program. I also acknowledge that as a Program Volunteer or Recipient I will not be an employee of Cranberry Township and/or acting as an agent on behalf of the Municipality. I further understand that the undertaking of this activity may result in personal injuries and/or damage to private property and agree that the Municipality will not be responsible for any such property damage and/or personal injuries resulting from my participation in this Program. I further expressly agree that the foregoing RELEASE, WAIVER OF LIABILITY AND INDEMNITY AGREEMENT is intended to be as broad and inclusive as is permitted by the law of the Commonwealth of Pennsylvania and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.
20. Electronic Signature*
21. I/We recognize the electronic signature(s) as an authorized signature of the release form.

    1. Yes
    2. No
23. *If signatory is under 18 years of age, this must also be signed by a parent or guardian.
25. Parent/Guardian signature
26. I/We recognize the electronic signature(s) as an authorized signature of the release form.

    1. Yes
    2. No
28. If you require an emergency response from the Sewer and Water or Public Works Departments, call 724-720-6464.
30. DO NOT use this form if you need an immediate response from Police, Fire or EMS. Call 9-1-1.
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32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

* indicates a required field