Organizer:
Address details:

To the city of: Antwerp/Bruges/Ghent/Leuven/Mechelen/Ostend*

       Declaration of Exemption

I pledge in the name of the holder of the permit for the following event

………………………

(description, shooting period and place of the event)

1. To exempt the Flemish Community, the Cities, their departments, and other public corporations from paying any damages which could be claimed by participants and third parties in connection with the event due to legal liability regulations

2. And further, I pledge to take over the indemnification payments for damage caused in connection with the event or its execution to the public space and its infrastructure  – even if it is not the caused by  the participants

... (signature)

... (name)

...(place and date)

* Delete where not applicable