Volunteer Information Form

Name of Volunteer *

First Name

Last Name

Volunteer participant under age 18 *

True

False

If so, please provide Parent/Guardian Name

By providing your name, you are stating that you are legally responsible for the minor volunteer.

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

T-shirt size?

Small

Medium

Large

X-Large

XX-Large

Date

MM

DD

YYYY

Would you like to be contacted for future City of Lima volunteer projects? *

Yes

No

Agreement to Participate and Release and Waiver *

In consideration of permission to participate in the City of Lima Volunteer Program sponsored in part or in whole by the City of Lima, I , intending to be legally bound, hereby, for myself, my heirs, executors, and administrators, voluntarily assume all risks of accident or injury and release and forever discharge the City of Lima and its co-sponsors and their employees, officers and agents from any and all liability for personal injury or property damage of any kind sustained in association with participation in the program, whether such personal injury or property damage is caused by the negligence of the City of Lima, its co-sponsors or their employees, officers, or agents, or otherwise. I covenant and agree to indemnify and hold harmless the City of Lima and its co-sponsors, their employees, officers and agents, from all liability, loss and expense, including but not limited to damages, legal expenses and cost of defense, in any matter arising from my participation in the City of Lima Volunteer Program. I further agree to abide by all applicable rules and regulations promulgated by the City of Lima and its co-sponsors and agree to follow the instruction of all supervisors and/or instructors who are connected with this program.

I Agree

I have received Safety Instructions as related to this project. *

True

False