Volunteer In Parks and Rec (VIPAR)

Volunteer First Name *

Volunteer Last Name *

Physical Address *

City *

State *

ZipCode *

Volunteer Email Address

Volunteer Phone Number *

Emergency Contact First Name *

Emergency Contact Last Name *

Emergency Contact Relation to Volunteer *

Emergency Contact Phone Number *

Other

Agreement and Release of Liability *

By my initials below I certify that all of the information and statements provided by me in and with this application are true and correct. It is understood and agreed upon that any misrepresentation or omission by me in this application will be sufficient cause for cancellation of this application and forfeiture of my opportunity to volunteer with the City of Livingston.

Release of Liability *

In consideration of being allowed to participate as a Volunteer for the City of Livingston, I acknowledge that working on municipal projects may be unintentional hazardous activities and I assume all risks associated with this volunteer opportunity. I waive all claims for damages against the city and against its officers, agents, and employees for injury to my person or property, including death and destruction that may arise from activities. I further understand that I am working as a volunteer, not an employee, and I am not entitled to any compensation for the volunteer activities I perform. I release the city and its officers, agents, and employees and agree to hold them harmless from any such liability.

Name of Child/Individual

Parental Consent (if applicable) If the volunteer is under the age of 18, or under a disability, a parent or guardian must complete the form below. Volunteers under the age of 18, or under a disability, must have consent of a parent or guardian. All legal guardians must sign/initial application form accordingly.

Parental Consent (if applicable)

In consideration of our child/individual is allowed to participate in a volunteer capacity for the City of Livingston, we acknowledge that working on municipal projects may be unintentionally hazardous. Nevertheless, we grant permission for our child to participate in this activity and we understand and assume all the risks associated with this work. We waive all claims for property damage and personal injury, including death and destruction and resulting injuries and damages that may arise from this activity. We further understand that our child/individual is working as a volunteer, not an employee, and is not entitled to any compensation for the volunteer activities they perform. We release the city and its officers, agents, and employees and agree to hold them harmless from any such liability. This agreement shall remain in force until we revoke it in writing.

Electronic Signature *

Electronic Signature Agreement: By typing the full name of the responsible person (self or Parent/ Guardian), you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

Volunteer In Parks and Rec (VIPAR)

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