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2. Name*
4. Address*
6. Phone Number*
7. Work Number*
9. Location to unload (driveway, yard, on tarp, etc.)
11. Amount of Material*

13. The undersigned agrees to receive a delivery of ground yard waste from the City of Kent at the above-designated location and agrees to hold the City of Kent harmless for any damage at said location. In addition, the City of Kent makes no representations to the quality or composition of the delivered materials. In fact, to further state, the product being delivered is made from materials brought to the yard waste site by residents. The materials are a mixture of grass clippings, brush, branches, firewood, leaves, and weeds (any type of yard waste). Therefore, the City is not responsible for any weeds or noxious growth that could result due to placement of said materials on the property listed above. Once the product is delivered to the address above, it becomes the sole property of the owner. Please note that supplies are limited and delivery of material is subject to availability and that the City reserves the right to limit the amount of material delivered to each specific location in order to be fair to all residents. 

15. Signature*
17. Date*
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