LAMI Volunteer Information Form and Waiver

Liability Waiver

Physical Activity, Pre-Existing Condition, and Publicity Authorization Release for Volunteers
I, release the Los Angeles Maritime Institute, its officers, employees, volunteers, and contractors from responsibility for personal injury or liability while engaged in the activities as a volunteer and participating in the operation of the institutes vessels and the execution of the TopSail Youth Program. I understand that this activity may require physical conditioning, and I certify that I am in appropriate physical condition to perform the duties for which I will volunteer. I understand that there is an element of risk in these activities and agree to follow all instructions, rules and regulations.
Full Name
I also understand that I may participate without volunteering to climb the rig, go forward on the bowsprit or in any way leave the deck of the vessel.
Please list pre-existing conditions which may affect and or prohibit your participation in the required activities of the position you have accepted.
I further release the Los Angeles Maritime Institute, its officers, employees, volunteers, and contractors from the responsibility for these pre-existing conditions and should they be aggravated or re-injured in the course of executing the responsibilities for whichI have committed to.
Emergency Contacts
Full Name
Relationship
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Full Name
Relationship
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Full Name
Relationship
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Volunteer
Full Name
Date

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

Volunteer Information Form

Liability Waiver

Emergency Contacts

Volunteer