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Emergency Contact Information <br />Name of person to contact in case of emergency: <br />Relationship: Phone number: <br />Address: <br />Ciry: State: Zip Code: <br />Volunteer Waiver and Release <br />I understand that this is an application for, and not a commitment or promise of, a volunteer opportunity. I <br />certify that this information is true, correct and complete to the best of my knowledge. <br />If accepted for a volunteer opportunity, my participation in the activity is voluntary and on the city's behalf. I <br />agree to be subject to the city's direction and control. <br />I know, and am aware of, the dangers associated with my participation in this activity. Said risks may include <br />injury or accident to person or property, or other loss. I assume any and all risks, whether known or <br />unknown, while volunteering my services. <br />I understand and agree that neither the city, nor any person acting on behalf of the city, may be held liable in <br />any way for any event which occurs in connection with this activity which may result in harm, death, injury or <br />other damage to me. This waiver of liability does not waive liability for any injuries that I obtain as the result <br />of willful, wanton or intentional misconduct by the city or any person acting on behalf of the city. <br />I agree to defend, indemnify, and hold harmless the city for any expense or liability the city may incur as a <br />result of my conduct, actions or omissions while performing this activity. <br />It is my express intent that this Waiver and Release shall bind the members of my family, if I am alive, and my <br />heirs, assigns and personal representatives if I am deceased. <br />I have read the above and understand the legal significance of signing this document. <br />Name (please print) <br />Signature Date <br />NOTICE: Volunteers under eighteen (18) years of age must have this Waiver and Release co-signed by their <br />parent or legal guardian. <br />I certify that I am the parent or legal guardian of the above individual and hereby consent to his or her <br />participation in this activity. I have read and understand the above Waiver and Release, and I agree to be <br />bound by the terms stated therein. <br />Parent/Guardian Name (please print) <br />Signature <br />Date <br />