Mid-Continent Railway Museum Volunteer Acknowledgement Form

Volunteer Acknowledgement Form

Mid-Continent Railway Museum
I hereby acknowledge that when I act as a volunteer for the Mid-Continent Railway Historical Society, Inc. the Workers Compensation insurance of Mid-Continent DOES NOT allow for medical or loss of time benefits to me while acting in that capacity. I fully understand that I must rely on my own health and disability coverages.

I further understand that I am afforded coverage as a volunteer under Mid-Continent's general liability and auto liability if I were to be named individually in a suit by a third party while acting on behalf of Mid-Continent. However, I acknowledge that I WILL NOT be allowed to recover damages from Mid-Continent for any injuries that I may sustain as a named insured under Mid-Continent's liability coverages.
Name of Volunteer
Name of Guardian (if volunteer is a minor)
Email
example@example.com
By marking the signature area below, I am indicating I understand and agree to the waiver terms.
Signature of Volunteer or Guardian

You may alternatively just write your initials in place of a full signature.
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty: