Volunteer Liability Waiver

Volunteer Liability Waiver Form
Name of the Volunteer*

First NameLast Name
Please Note: While we are appreciative of all individuals that inquire about volunteering with the City of Fort Lupton, we do ask that all volunteers are OVER the age of 14 years old.*

*For all volunteer applicants that are between 14- 17 years old, a parent or guardian must also sign this document.
I am under the age of 18 years old.I am over the age of 18 years old.
What is your current age:*
Volunteer Home Address*

Street Address

Street Address Line 2

CityState

Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
What is the date of completing this form?

MonthDayYear
Date

City of Fort Lupton Volunteering Opportunities
City Training/Exercise VolunteerCity Event VolunteerVolunteer Youth Sports CoachVolunteer Committee Board MemberRecreation Department VolunteerOther

Selected Volunteer Position Activities/Responsibilities

The following information describes the expected activities for this position
City Training and/or Exercise Volunteer:
Follow all provided safety measures, information, and briefings that occur during the orientation.

Participate as expected within the role that is assigned.

Other activites for this position may include possible activities such as sitting, standing, bending over, walking, carrying, lifting, typing, pulling, and/or pushing. 

Follow all instructions for "play" during the training and/or exercise that are given by the safety and/or control staff.
City Event Volunteer:
Assist with various tasks before, during, and after the event including set up and tear down.

Welcome attendees, answer questions, provide directions and information as needed.

Assist with crowd control, line management, and event activity flow.

Follow all safety and emergency response procedures.

Other activities for this position may include sitting, standing, bending over, walking, carrying, lifting, typing, pulling, and/or pushing.
Volunteer Youth Sports Coach:
Plan and supervise games, practices, and events.

Supervise assistant coaches or team parents.

Teach the young athlete the fundamentals of team sports.

Encourage the involvement of the parents in the sport.

Schedule and conduct parent and other necessary meetings.

Provide a safe and fun environment for the children.

Learn and follow all league rules, policies, and procedures.

Give each player equal playing time.

Put the feelings of players ahead of your desire to win.

Attend all league functions and participate in league activities.

Other activities for this position may include sitting, standing, bending over, walking, carrying, lifting, typing, pulling, and/or pushing. 

To view the Youth Sports Coach Additional Application, click below:
Fort Lupton Youth Coach Application
Volunteer Committee Board Member:
Attend and participate in committee meetings.
Review new and existing operations in requested areas and suggest appropriate course of action to City management and City Council.

Other possible activities may to include sitting, standing, bending over, walking, carrying, lifting, typing, pulling, and/or pushing. 

Specific duties and responsibilities vary from committee to committee and is available to all applicants on the City website: 


Committees, Boards, and Commissions Web Page
Recreation Department Volunteer:
Assist with various tasks related to recreational programming and services to include possible activities such as sitting, standing, bending over, walking, carrying, lifting, typing, pulling, and/or pushing. 

Follow all safety and emergency response procedures.

*This position may include driving a personal or city owned vehicle and is subject to a Motor Vehicle Record (MVR) check with the Department of Motor Vehicles.
Volunteer (Other):
A general volunteer position may be available for a department that may include:

-Assisting with administrative tasks, services, and activities.
- *Driving a personal or City-Owned vehicle (subject to a Motor Vehicle Report Request)
-May include sitting, standing, lifting, walking, carrying, pushing, pulling, typing, or other tasks that relate to the assigned department.

FOR ALL CITY OF FORT LUPTON VOLUNTEERS
I. RELEASE OF LIABILITY AND INDEMNIFICATION AGREEMENT: PARTICIPANT MUST READ BEFORE SIGNING
   I hereby volunteer my services to the City of Fort Lupton, Colorado (“City”) without compensation and shall at no time be considered an employee or contractor. Either the City or I may terminate my volunteer status at any time for any reason. I certify that I understand the inherent risks associated with acting as a volunteer including the risk of physical injury or death. I further understand that I risk aggravating any preexisting physical condition I may have and that I am hereby advised to consult with a physician prior to engaging in any physical exertion that may occur in providing these volunteer services. I understand I am not an employee of the City within the meaning of the Colorado Workers’ Compensation Act or for any other purpose at the time of my volunteering.

     I further understand that no employee/employer relationship is created between myself and the City and that I will receive no compensation of any kind for my participation as a volunteer. In consideration of the City allowing me to participate as a volunteer, which may include riding in or operating city equipment (machines, vehicles, carts, etc.) I agree not to sue and forever release, waive and discharge the City and its elected and appointed officials, employees, agents, representatives, and the various sponsoring agencies and entities (hereinafter referred collectively as “Releasees”) from any and all liability to me or my personal representatives, assigns, heirs, children, dependents, spouse and relatives for any and all claims, causes of action, losses, judgments, costs, demands or damages that are caused by or arise from any injury to me (including death) or loss or damage to my property regardless of the cause(s) of such injury, loss or damage, and the procurement of emergency medical attention. I assume all risks associated with my participation as a volunteer. I understand I have a duty to defend, indemnify, and hold harmless the Releasees from and against any and all liabilities, claims, liens, actions, causes of action, costs or expenses of any nature whatsoever arising from any damage, loss, or injury (including death) caused by me, in whole or part, or directly associated with my actions or inactions as a volunteer.    I authorize the City to obtain medical attention for me in case of an emergency. I acknowledge that the City has chosen to provide coverage for its volunteers through the Volunteer Accident Medical Plan (VAMP).

     I understand that the City shall not be responsible for loss or theft of my personal property, or damage to my personal property while I am acting as a volunteer for the City. I understand photos may be taken at event(s) where I may volunteer and the City has my permission of “free use of any photos.”

I hereby acknowledge that I have carefully read this entire document, that I fully understand its contents, that I am over the age of 18, that I am signing this document of my own free will and without coercion, and that I intend for this document to be legally binding. To the extent permitted by law, this document shall include my child or children and my capacity as guardian for my child or children if I am signing on behalf of my minor child or children who will participate as a volunteer(s).

II. PARTICIPANT SIGNATURE AND DATE

I hereby acknowledge and agree that I have read, understood, and voluntarily agree to the foregoing waiver, release, and indemnification agreement, and that this agreement shall be binding on me, my successors, representatives, heirs, executors and assigns.
Print Name*

First NameLast Name
Signature*

Clear

PARENT SIGNATURE AND DATE FOR PARTICIPANT UNDER 18 YEARS OLD

By signing below, I acknowledge that I am the parent of the above-named participant as the term “parent” is defined in C.R.S. Section 13-22-107(2)(b), and, in addition to execution of the foregoing on behalf of the participant, I hereby waive and release any prospective claim of the participant against the City/Town, its officer and its employees for negligence, to the extent provided by C.R.S. Section 13-22-107(3), in connection with the Activities.
Name*

First NameLast Name
Signature*

Clear

Emergency Contact & Medical

Please provide an emergency contact as well as your primary physician's name and phone number (if applicable).
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Name of Primary Physician

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.

Worker's Compensation Coverage and Volunteer Accident Medical Plan (VAMP)
As indicated by my signature, I verify I am not compensated as an appointed committee member or volunteer for the City of Fort Lupton.

I acknowledge that the City of Fort Lupton has chosen to provide coverage for its appointed committee members and volunteers through the Volunteer Accident Medical Plan (VAMP).

For committee members only:

My signature below also verifies that I have been notified that the City of Fort Lupton has chosen to exercise the option to exclude appointed committee members (also referred to as unpaid board members) from Worker's Compensation Insurance per C.R.S. section 8-40-202. In accordance with Colorado law, I acknowledge that my information is reported to the Department of Labor and Employment, Division of Worker's Compensation as part of the City's application for the Exclusion of Uncompensated Public Officials.
Printed Name*

First NameLast Name
Signature*

Clear
Date*

MonthDayYear
Date
Committee Name (If applicable)

THANK YOU!

Thank you for taking the time to become one of our City Volunteers.
Please review all of the information that has been provided on this form for accuracy before submitting. Once submitted, the appropriate supervisor will review the application and contact you regarding you inquiry.

Please note, some positions require additional steps and information to ensure the safety and security of our City and it's residents. If you have any questions about this process, please reach out to the appropriate individuals that will be listed on the "Thank You" page after submission.
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Volunteer Liability Waiver Form

City of Fort Lupton Volunteering Opportunities

Selected Volunteer Position Activities/Responsibilities

FOR ALL CITY OF FORT LUPTON VOLUNTEERS

I. RELEASE OF LIABILITY AND INDEMNIFICATION AGREEMENT: PARTICIPANT MUST READ BEFORE SIGNING

II. PARTICIPANT SIGNATURE AND DATE

PARENT SIGNATURE AND DATE FOR PARTICIPANT UNDER 18 YEARS OLD

Emergency Contact & Medical

Worker's Compensation Coverage and Volunteer Accident Medical Plan (VAMP)

THANK YOU!