Volunteer Emergency Waiver/Release & Confidentiality Agreement

Potter Park Zoo

Ingham County
Emergency Waiver and Release Form

& Confidentiality Agreement
Welcome to Potter Park Zoo's Volunteer Program!

In order to volunteer, each participant (or if under 18, then the participant's parent/guardian) must complete this form.*

If you are volunteering with a group or for an organization's volunteer day, please be sure to select the "Volunteering with a Group/Organization" option AND indicate the group name or name of volunteer day (such as Spartan Day of Service) in the Group Name section.

If you have any questions, please call Kelly Gibson, 517-342-2717 or email ppzvolunteer@ingham.org.

*We do have paper copies of this form if you prefer to come to the zoo to complete it. This format, however, helps us reduce paper usage and saves time in the volunteer on-boarding (check-in) process.
Date*

MonthDayYear
Volunteer Role - IMPORTANT - please select the accurate option below:*

Not Part of a Group - Individual Volunteer - ADULTADULT - Volunteering with a Group/Organization (including Spartan Day of Service) - Group Volunteer - ADULTNot Part of a Group - Individual Volunteer - UNDER 18UNDER 18 - Volunteering with a Group/Organization (including Spartan Day of Service) - Group Volunteer - UNDER 18
Group/Organization Name (Please put group name exactly as stated in Potter Park Zoo email)*
Please put complete name.
Date your group will be volunteering:

MonthDayYear
Date Group is Volunteering
Group Contact Name, as stated in Potter Park Zoo Volunteering Email*
Please include contacts first and last name.
Volunteer Participant's Name*

First NameLast Name
Volunteer's Address*

Street Address

Street Address Line 2

CityState

Zip Code
Volunteer's Phone Number*

Area CodePhone Number
Volunteer's Email*
example@example.com
Participant's Date of Birth*

MonthDayYear
IMPORTANT - PLEASE READ THE BELOW

Potter Park Zoo

Ingham County

Emergency Waiver and Release Form - Volunteer Program

IN CONSIDERATION of being permitted to participate in a volunteer program at Potter Park Zoo, I (the undersigned participant or parent/guardian), INTENDING TO BE LEGALLY BOUND, do hereby, for myself or the below named participant, my heirs, executors, administrators and representatives, ASSUME ALL RISK INHERENT IN PARTICIPATION, and further agree to, and do hereby release, waive, discharge, covenant not to sue and indemnify the Potter Park Zoological Society or Ingham County, its officers, employers, sponsors, volunteers, representatives and agents, of and from any claim in law or equity for injury or damages of any type whatsoever which I or her/he or they may make or incur arising out of my (or the below named participant's) participation in the aforementioned activity, including payment of legal fees or costs incurred by the County in defending any such claim.

In addition, I authorize and grant permission to the Ingham County, Potter Park Zoo and Society staff to secure emergency medical and/or hospital treatment for myself or the below named participant in the volunteer program.

I also authorize and grant permission to the County to photograph or videotape myself or the below named participant and waive any claims by or on behalf of myself or the below named participant for remuneration for any form or use of such photographs/video tapes when used for educational program, public relations programs, and newspaper use.

I AM FULLY AWARE OF ALL THE INHERENT RISKS ASSOCIATED WITH MY PARTICIPATION AND DO HEREBY ASSUME AND ACCEPT ALL SUCH RISKS. I AM NOT AWARE OF ANY CONDITION, PHYSICAL OR OTHERWISE, WHICH COULD BE AGGRAVATED, WORSENED OR OTHERWISE ADVERSELY AFFECTED BY PARTICIPATION (or myself or the below named participant) IN THE VOLUNTEER PROGRAM AT POTTER PARK ZOO.

I am signing the Emergency Waiver and Release form of my own free will and volition and I acknowledge that I have read this Emergency Waiver and Release Form and fully understand it and that I am of legal age to execute this Agreement.
By signing the below with my official e-signature, I agree to contents of the above emergency waiver and release form on this date of submission.
Volunteer Participant's TYPED Name, matching signature below*

First NameLast Name
Volunteer Participant's Signature*

Clear
Signed on this date*

MonthDayYear
Date
Parent or Guardian to complete for any volunteer under age 18.

Signatures may be verified to ensure a parent/guardian are the actual signers.
If the participating volunteer is under the age of 18, a parent or legal guardian must sign this waiver before the volunteer may participate in any activities at or for Potter Park Zoo.
Volunteer Participant's Name*

First NameLast Name
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Email*
example@example.com
Parent/Guardian Phone*

Area CodePhone Number
Parent/Guardian Signature*

Clear
Signed on this date*

MonthDayYear
Date
Emergency Contact*

First NameLast Name
Emergency Contact Phone Number*

Area CodePhone Number
Relationship to Volunteer*

Potter Park Zoo Confidentiality Agreement

Volunteer Program
I agree to keep confidential all information pertaining to the exhibits, animals and grounds of Potter Park Zoo, in which I am a volunteer. I understand that the trust of the public in Potter Park Zoo and safety of the animals may depend on such confidentiality.

Specifically:

I will not discuss any animal births, transfers, illnesses or deaths until after the information is released to the public by the Zoo Director or Zoological Society Executive Director.

I will not discuss any zoo information with any form of media without the permission of Potter

Park Zoo and/or the Potter Park Zoological Society staff.

I will not post behind-the-scenes pictures of myself, others, exhibits or animals, or confidential

information on any social media outlet. Furthermore, I will abide by any guidelines regarding photography of any sort by the staff.

I understand that any breech of this confidentiality agreement could result in my dismissal from volunteer service with the Potter Park Zoological Society.
Volunteer Participant's TYPED Name, matching signature below*

First NameLast Name
Volunteer Participant's Signature *

Clear
Signed on this date*

MonthDayYear
Date
Parent or Guardian to complete for any volunteer under age 18.

Signatures may be verified to ensure a parent/guardian are the actual signers.
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Signature*

Clear
Signed on this date*

MonthDayYear
Date
Should be Empty:

Potter Park Zoo

Parent or Guardian to complete for any volunteer under age 18.

Potter Park Zoo Confidentiality Agreement

Parent or Guardian to complete for any volunteer under age 18.