Volunteer Registration and Medical Authorization Form

Registration and Emergency Medical Authorization Form

Please fill in the form below.
Full Name

PrefixFirst NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Are you 17 years old or younger?
Parent and/or Legal Guardian

First NameLast Name
Parent and/or Legal Guardian Phone Number

Area CodePhone Number
Gender
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Number

Area CodePhone Number
E-mail
Would you like to subscribe to our monthly e-newsletter?
Emergency Contact

First NameLast Name
Relationship
Emergency Phone

Area CodePhone Number
Do you have any allergies (food or medicine) or special medical problems?
If yes, please describe.

Do you have minors that will be volunteering with you?
Volunteers under the age of 17 must be accompanied by a parent/legal guardian or adult during the entire length of the event.
Minors
First and Last Name. Include birth date.
Release, Waiver of Liability and Assumption of Risk

By signing this Registration and Emergency Medical Authorization Form (the“Registration Form”), the undersigned (the “Participant”) hereby releases and discharges Friends of Grand Rapids Parks (“FGRP”) and its officers, directors,employees, contractors, agents and any other related parties(“Representatives”) from any and all actions, claims, and/or demands for damages, wrongful death, or personal injury that the Participant now has or may have in the future arising out of an injury or loss sustained as a result of participation in FGRP activities or events. Furthermore, the Participant agrees that the Participant and his/her assignees, heirs, guardians, and/or legal representatives shall not make a claim against or bring suit against FGRP or its Representatives for any injury or damage resulting from the acts of FGRP and/or its Representatives, however, such acts are caused and whether such acts are active or passive.
Medical Release and Waiver

The Participant hereby authorizes FGRP and its Representatives to take whatever actions may be necessary to obtain emergency medical care in the vent such care is warranted. These actions may include, but are not limited to,the following: (1) attempting to contact the Participant’s relative, parent, guardian or other emergency contacts; and (2) calling 911 for emergency assistance and allowing emergency personnel to transport the Participant by ambulance or otherwise to a hospital as recommended by such emergency personnel. The Participant understands that the Participant shall be solely responsible for any and all medical costs incurred as a result of a medical emergency and subsequent treatment.
Photo Release

The Participant hereby grants FGRP the right to use the Participant’s image and/or likeness for publication and promotional purposes. The Participant agrees that FGRP may use the Participant’s image and likeness in any form and in any forum, including, without limitation, print, video, and/or other analog or digital form via the internet, television, or other promotional or display medium. The Participant further agrees that any uses described may be made without additional compensation or consideration. The Participant grants FGRP the right to crop or treat the Participant’s image and/or likeness in its sole discretion and agrees that FGRP may choose to use such image and likeness now or at a later date. The Participant hereby waives any right to inspect or approve any finished work that includes the Participant’s image or likeness.
By submitting this Registration Form, the Participant acknowledges that the Participant has carefully read this Registration Form and fully understands and consents to its contents. The Participant also acknowledges that the Participant signs this form of its own free will.
Agreement
Date

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

Registration and Emergency Medical Authorization Form