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Contact Information

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Contact Information

First Name	Last Name
Address	City
State(Select State) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming	Zipcode
Phoneext.	Email
Special Needs/Considerations

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Have you ever been convicted of a felony or misdemeanor requiring imprisonment or fine in excess of $50?

Have you ever been convicted of a felony or misdemeanor requiring imprisonment or fine in excess of $50?

Yes

No

3

I do hereby fully and forever waive, release, discharge, and hold harmless the Town of Garner, its agents, elected and appointed officials, employees and volunteers from any and all claims, suits, demands, damages and causes of action, present or future, foreseeable or unforeseeable resulting from or arising out of the above described activity or use by the event manager/demonstrator/vendor or by any third parties.  I understand that this waiver and release precludes my right to recover damages in the event I am injured during my participation in the special event.  I shall defend and indemnify the Town of Garner in any claim or cause of action arising from my negligent or intentional acts or omissions in performing my volunteer duties.

I understand that I may suffer accident or injury as a direct or indirect result of participation and agree to assume all risk involved in participation.  In the event of an injury, I will not hold the Town of Garner, agents, volunteers, or employees responsible or liable. I also release any photographs or videos taken during this program to be used as promotional purpose.

 I agree to abide by the Volunteer Code of Conduct:

• I will fulfill the responsibilities of my assignment.
• I will set a good example for the participants.
• I will demonstrate good citizenship and cooperation.
• I will be vigilant and aware of the safety of the participants.
• I will encourage and foster independence.
• I will be an advocate for full inclusion by ensuring equal access to all activities.

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I understand and agree that I will provide the services described and authorized by the Garner Parks and Recreation Department; that my volunteer work is governed by the same ethical and quality standards regulating Town employees; and agree to abide by all Town and Department policies and procedures.

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Date

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Date

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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