Student Volunteer Application

Please complete this application if you are interested in becoming a Roselle Park District volunteer. Once you complete the form, click the SUBMIT button at the bottom. A parent/guardian MUST read the waiver and sign in the signature box.

Parent/Guardian Informed Consent and Signature Box

IMPORTANT INFORMATION

The Roselle Park District (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 Roselle 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 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. Additionally, 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.

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 before seen. 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 Park District to guarantee absolute safety.

WAIVER AND RELEASE OF ALLCLAIMS AND ASSUMPTION OF RISK

Please read this form carefully and be aware that inconsideration 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 Roselle Park District including its officers, officials, agents, volunteers and employees (herein after 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.

I have read and fully understand the above important information, warning of risk, assumption of risk and waiver and release of all claims. If registering 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 also acknowledge that my minor child and I have read the Volunteer Handbook.

Please read carefully: The information provided on the Authorization is true and correct to the best of my knowledge. I understand that failure to reveal any prior addresses in the past five years and/or the giving of false or misleading information on my application or in an interview may result in the refusal of or separation.

I authorize the above company and its representative to make an independent investigation of my background, references, character, past employment, education, criminal records, and for driving positions, motor vehicle information, as required by Section 391.23 of the Federal Motor Carrier Safety regulations, maintained by a public and private organization. Additionally, I authorize the above company to access my credit information at any time they deem it necessary. I understand that the results of the investigation may result in refusal of or separation from employment, credit, or living quarters.

I release the above company and/or its representatives from any and all liability, claims, or lawsuits in regard to the information obtained from any or all of the above reference sources used in the verification of my background. I also acknowledge that the above company may be requested to submit certain information with regard to my employment and/or application to various government agencies or private organizations. I hereby authorize the above company to provide such information and release the above company and its representatives from any liability for submitting such information.