HPD Volunteer Application & Waiver

VOLUNTEER APPLICATION & WAIVER
PERSONAL INFORMATION
Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State

Zip Code
Cellphone Number *
Please enter a valid phone number.
Age *
Volunteer Email Address *
example@example.com
Emergency Contact Name *

First Name Last Name
Emergency Contact Phone Number *
In what area are you applying to volunteer? *
Have you ever been convicted of, or found to be a child sex offender? *

Yes No
If marked yes, which state? *
*Pursuant to Illinois Law 70 ILCS 1205/8-23a "those applying to become volunteers must disclose such convictions."
Signature of Applicant *

Clear
Date

Month Day Year
By signing this application, I acknowledge that I have reviewed the Volunteer Handbook located on the Huntley Park District volunteer web page (www.huntleyparks.org/volunteer).
Note: Per Illinois Law a parent or legal guarding of a minor child "may" fill out the application on behalf of their legal dependent. Parental signature is not a requirement.

VOLUNTEER WAIVER & RELEASE
IMPORTANT INFORMATION

The Huntley Park District is committed to conducting its recreation programs and activities in a safe manner and holds the safety of volunteers in high regard. The Huntley Park District continually strives to reduce such risks and asks that all volunteers follow safety rules and instructions that are designed to protect the volunteer's safety. However, volunteers must recognize that there is an inherent risk of injury when choosing to volunteer for any activity or program.

Please recognize that the Huntley Park District carries only limited medical accident coverage for volunteers; therefore, it is strongly urged that all volunteers review their own health insurance policy for coverage.

Volunteers are not covered under the workers' compensation insurance of the Huntley Park District and the Park District recommends that volunteers review their own health insurance policy for coverage. Volunteers are covered under the general liability insurance of the Park District for liability arising out of and within the scope of their volunteer duties, subject to the terms, conditions, and exclusions of the general liability coverage document. The Park District does not provide insurance coverage for any personal property, equipment, or vehicle owned by the volunteer.

Volunteers for the Huntley Park District will be expected to observe the ordinances, policies and procedures of the Huntley Park District while volunteering.

Depending on the nature of the volunteer function, volunteers may be required to complete a training program for the particular function. All volunteers are expected to fully comply with directions from supervisory staff. Depending on the nature of the volunteer duties, volunteers may be required to successfully complete a criminal background check and/or driver's abstract through the Illinois Secretary of State's Office.

All volunteers serve at the will of the Huntley Park District. The Huntley Park District may terminate the services of a volunteer at any time and for any reason or no reason at all, with or without notice, and volunteers retain the same right and may terminate their volunteer services for the Park District at any time and for any reason, with or without notice.
STATEMENTS OF ADMISSION

ISSUE

The Huntley Park District practices good risk management techniques to reduce the risks of unforeseen accidents. However, accidents can and do happen. After an accident, many questions will be asked of the park district staff, such as: "Who will pay for the damage, who was at fault, what could the park district have done to prevent the accident?" Employees may provide inadequate information, may not know all of the facts, or be confused due to the accident. To provide the most consistent information to the public and possibly media outlets, please review the "Statement of Admission" policy below.

STATEMENTS OF ADMISSION

When an accident occurs, no matter how insignificant it may seem, it is of the utmost importance never to admit to guilt or negligence of any kind until there is a formal investigation of the matter by your supervisors, and the causes of the incident have been determined. You are required to contact your immediate supervisor and not to render speculation on the causes of the incident. Any and all questions relating to an accident involving District property and/or personnel must be directed to a department head or other designated manager.
WARNING OF RISK

Despite careful and proper preparation, instruction, medical advice, conditioning and equipment, there is still a risk of serious injury when providing volunteer services. Understandably, not all hazards and dangers can be foreseen. Volunteers must understand that depending upon the volunteer services, certain risks, dangers and injuries due to acts of God, inclement weather, slip and falls, inadequate or defective equipment, failure in supervision or instruction, premises defects, horseplay, carelessness, lack of skill or technique, and all other circumstances inherent to the particular volunteer services exist. In this regard, it must be recognized that it is impossible for the Huntley Park District to guarantee absolute safety.
WAIVER AND RELEASE OF ALL CLAIMS AND ASSUMPTION OF RISK

Please read this form carefully and be aware that in consideration for providing volunteer services, you will be expressly assuming the risk and legal liability and waiving and releasing all claims for injuries, damages or loss which you may sustain as a result of participating in any and all activities connected with and associated with your volunteer services (including transportation services/vehicle operations, when provided).

As a volunteer, I recognize and acknowledge that there are certain risks of physical injury to volunteers in this program/activity, and I voluntarily agree to assume the full risk of any and all injuries, damages or loss, regardless of severity, that I may sustain as a result of my volunteer services. I further agree to waive and relinquish all claims I may have (or accrue to me) as a result of my volunteer services against the Huntley Park District including its officers, officials, agents, volunteers and employees (hereinafter collectively referred as "Parties").

I do hereby fully release and forever discharge the Parties from any and all claims for injuries, damages, or loss that I may have, or which may accrue to me and arising out of, connected with, or in any way associated with my volunteer services.

Each volunteer is solely responsible for determining if he/she is physically fit and/or properly skilled for any volunteer activity. It is always advisable, especially if the volunteer is pregnant, disabled in any way or recently suffered an illness, injury or impairment, to consult a physician before undertaking any physical activity.

I have read and fully understand the above important information, statements of admission, warning of risk, assumption of risk and waiver and release of all claims. If submitting on-line or via fax, my on-line or facsimile signature shall substitute for and have the same legal effect as an original form signature.

I authroize Huntley Park District to conduct a Criminal Background Check.
Signature *

Clear
Date

Month Day Year
Date
Should be Empty:

VOLUNTEER APPLICATION & WAIVER

PERSONAL INFORMATION

VOLUNTEER WAIVER & RELEASE