Volunteer Signup Form w/ Liability Waiver (2024)

Volunteer Waiver and Release of Liability Statement

Please review and fill in the fields below.

In the event of an emergency, please contact the following person(s) in the order presented:

I also consent to all emergency medical treatment, as may be deemed appropriate under existing circumstances by medical personnel or personnel associated with this event and authorize medical personnel or facility personnel to provide all emergency medical care deemed necessary, including but not limited to, first aid, CPR, the use of AEDs, emergency medical transport, and sharing of medical information with medical personnel. I further agree to assume all costs involved and agree to be financially responsible for any costs incurred as a result of such treatment. I am aware and understand that I should carry my own health insurance I have read and agree

to all of the terms set forth.

THIS WAIVER AND RELEASE OF LIABILITY SHALL REMAIN IN EFFECT FOR THE DURATION OF MY

PARTICIPATION IN THE ACTIVITY, DURING THIS INITIAL AND ALL SUBSEQUENT EVENTS OF

The above information is true to the best of my knowledge. / have read and understand the release statement in its entirety and wish to participate in this event.

Emergency Contact Name*

First NameLast Name

Emergency Contact Relationship*

Emergency Contact Phone #*

Please enter a valid phone number.

Volunteer Signature*

Date*

Date

Telephone Number*

Are you prepared to undergo and successfully clear a Level 2 background check and fingerprinting?