Volunteer Registration And Liability Waiver Form printable pdf download

THE UNIVERSITY OF ALBERTA

VOLUNTEER REGISTRATION AND WAIVER OF LIABILITY AGREEMENT

WARNING- BY SIGNING THIS FORM,

YOU GIVE UP IMPORTANT LEGAL RIGHTS! PLEASE READ CAREFULLY!

(MUST PRINT)

NAME OF VOLUNTEER:

_______________________________________________________________________________

ADDRESS OF VOLUNTEER: _______________________________________________________________________________

CITY:________________________ PROV:________ POSTAL CODE:____________________

BIRTH DATE: ___________________

PHONE NO: _________________________

EMERGENCY CONTACT: ____________________________________________________________________________________

RELATIONSHIP: ___________________________________

TELEPHONE NO: __________________________________

DUTIES: (identify briefly duties to be performed): ___________________________________________________________________

_____________________________________________________________________________________________________________

DEPARTMENT / FACULTY :

SUPERVISOR: ________________________________________ Telephone No. _________________________________________

DATES: From: ______________________________________

To: ___________________________________

LOCATION (where duties will be performed): ______________________________________________________________________

(Department/Faculty: Please contact the Office of Environmental Health and Safety (492-1810) for safety training and/or

immunization if applicable. Note that immunization protection from certain diseases may require a 3 month lead time.

TO: THE GOVERNORS OF THE UNIVERSITY OF ALBERTA

In consideration of my volunteer work, I understand that I am not entering into an employment relationship with the University of

Alberta and that I am not entitled to receive a salary or any employee benefits. I understand that my duties and responsibilities have

been explained in detail. I understand that either the University or myself may terminate this volunteer relationship at any time without

notice. I also understand that I have an obligation to respect the confidentiality of any sensitive information or dealings, which may

relate to my volunteering at the University and I agree that I will not disclose any information without the prior written authorization

from the University of Alberta. I understand that my obligation of confidentiality continues into perpetuity.

Initials ____________

ASSUMPTION OF RISK

I acknowledge that I am aware there are risks associated with or related to the duties described above that I will be required to perform.

These risks include, but are not limited to:

1. the risks associated with travel to and from locations where my duties will be performed including transport by public or private

motor vehicle, bus, train or other alternate transportation system.

2. any manner of injury resulting from use or misuse of equipment/tools required to perform my duties.

3. any manner of physical or mental injury (including death) that could result from being on University of Alberta property while

carrying out my volunteer duties.

I freely accept and fully assume all such risks, dangers and hazards and the possibility of personal injury, death, permanent disability,

property damage or loss resulting thereof.

Initials: _________

Volunteer Registration And Liability Waiver Form