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Volunteer Application For Traveling Storytime Template - Wal-Mart Children S Library Page 4

WAIVER OF LIABILITY

I hereby request permission of the City of Rogers and its’ agencies (hereafter collectively

referred to as “City”), to volunteer to work at and participate in the activities of the City. In

consideration for such permission, I agree to follow all instructions given by any City employee; I

accept full responsibility for my own personal safety; I waive any and all rights or claims against

the City in the event of any accident, incident or injury; and I do hereby release any and all

employees of the City, and all individual members of the City staff from any and all liability for

any injury that I could or do sustain while participating in City activities or service. I understand

that working with City employees while performing City functions can be unpredictable and

dangerous, and I hereby assume the risks associated with undertaking those activities. In the

event of an accident or injury, I authorize the City to notify _______________________at the

following phone number ______________________________________.

I have read the above waiver and agree to follow the instructions I am given. I understand that,

in the event that I am injured, I am forfeiting any claim, including fees, costs, expenses,

compensation, or any sums from any City source whatsoever, against the City or its employees

or agents. I further understand that the City of Rogers and its’ agencies are immune from liability

and from suit for certain damages except to the extent that they may be covered by liability

insurance and that no tort action shall lie against any such political subdivision because of the

acts of its’ agents and employees. (See A.C.A. 21-9-301 for specific information) I further

understand that this Waiver shall remain valid indefinitely or until revoked by me, in writing, with

at least 7 days prior notice given to the City of Rogers.

____________________________________________

NAME (PRINT)

____________________________________________

SIGNATURE

____________________________________________

ADDRESS

____________________________________________

DL OR ID #

ID VERIFIED BY ______________________________ (Employee)

Volunteer Application For Traveling Storytime Template - Wal-Mart Children S Library Page 4