Park Ambassador Volunteer Service Profile

PARK AMBASSADOR
VOLUNTEER SERVICE PROFILE
Basic Contact Information
Full Name*
Please type your first and last name.
Other Names (e.g. maiden name)
Please list any other names you have gone by.
Nickname/Preferred Name (if applicable)
e.g. "Katie" instead of Katherine
Address (IU Students - please use local address, if from out of town)*

Street Address

Street Address Line 2

CityState

Zip Code
Phone*
Please enter a valid phone number.Format: (000) 000-0000.
E Mail Address (used as primary communication)*
This is used as our primary channel of communication. Please do NOT use an email used for marketing emails, mailing lists, etc.
Date of Birth*

MonthDayYear
Emergency Contact*
Provide the name of a family member or friend we should call in the event of an emergency.
Relationship to you*
e.g., Parent, Spouse, Friend
Emergency Contact Phone*
Please provide your emergency contact's phone number. Format: (000) 000-0000.
Volunteer Assignment
Program:
Park Ambassador

Service Term:
24 Months (May 1-April 30)

Intended # of Hours:
Varies (min. one visit/week)

VOLUNTEER AGREEMENT

While serving as a volunteer, I understand that I serve as a representative of the Bloomington Parks and Recreation Department. I agree to act in accordance with the Bloomington Parks and Recreation standards, to take a proactive role in my volunteer position, and to actively participate in any reflection activities that may be incorporated into my service experience.
BACKGROUND CHECK AUTHORIZATION

Please read the following statement carefully before signing below:

I hereby authorize the City of Bloomington to conduct criminal background checks to determine my eligibility for employment or continued employment. I understand that the City is asking for my date of birth, previous names, and previous addresses only in order to conduct background checks and for no other reason.

By signing below, I hereby authorize the City of Bloomington to conduct background checks on me. I hereby release the City of Bloomington from any liability related to the procurement and/or disclosure of any information provided by me or obtained about me in connection with my application for employment with the City of Bloomington. I understand that any information gathered as a result of background checks will be kept confidential. I make this waiver knowingly and voluntarily.
WAIVER OF LIABILITY/PHOTO & VIDEO RELEASE

Please read the following statement carefully before signing below:

I recognize that because of the inherent hazards of this activity, that I may sustain some injury. In the event that I am injured and my next of kin cannot be contacted, I give my permission to the attending physician to render such treatment as would be normal, and agree to pay the usual charge for such treatment. I now release the City of Bloomington, its Parks and Recreation Department, and its employees, agents and assigns for any and all claims for personal injury and/or property damage that may arise from, or be in any way connected to, my participation in this activity. I understand that this release applies to both present and future injuries, and that it binds my heirs, executors and administrators. I may be photographed and videotaped while participating in Parks and Recreation activities, and consent is given for the reproduction of such photos or videos for advertising and publicity. I release Bloomington Parks and Recreation, its employees, agents, and assigns, from any liability connected with taking, recording, digitizing, or publication and use of photographs, video, and/or sound recordings. In signing this form, I also understand that I agree to be subscribed to the Bloomington Parks and Recreation monthly volunteer newsletter. I have read this release and understand all of its terms. I sign it voluntarily and with full knowledge of its significance.
Name (Printed)*
This acknowledges that you have read the statements above and agree to the terms.
Should be Empty:

Basic Contact Information

Volunteer Assignment

VOLUNTEER AGREEMENT

BACKGROUND CHECK AUTHORIZATION

WAIVER OF LIABILITY/PHOTO & VIDEO RELEASE