Volunteer Waiver And Release Form printable pdf download

VOLUNTEER WAIVER AND RELEASE

Participant:____________________________________________________________________________________

Last

First

Address:__________________________________________________________________Apt.________________

City & State:_______________________________________________________________Zip:________________

Telephone: Home:_____________________

Cell:______________________

I intend to volunteer at ____________________________________________________ (“Organization”) on days

and at times agreed upon by me and the Organization (“Services”). The volunteer services shall generally consist of

the following types of activities: __________________________ ________________________________________.

I acknowledge and agree that I am required to act and perform any services in a mature, responsible and

professional manner at all times during the Services and further acknowledge and agree that I will be held

responsible for my own behavior.

I acknowledge and agree that I must observe all federal, state and local laws and all rules, regulations and

policies of Florida Atlantic University (“University”) and the Organization.

In exchange for the University arranging for me to participate in the Services, I give the University the right

and permission to record my participation and appearance on videotape, audiotape, film, photography or any other

medium and to use my name, likeness, voice and biographical information in connection with these recordings. The

University may exhibit or distribute all or any part of these recordings for any educational or promotional purpose

which the University and its employees deem appropriate. All such recordings shall be the University’s property.

In exchange for the University arranging for me to participate in the Services, I, on behalf of myself, my

spouse, family, heirs, beneficiaries, and personal representatives, agree to assume all the risks and responsibilities of

participating in the Services. I release and forever discharge and covenant not to sue the Florida Atlantic University

Board of Trustees, the Florida Board of Governors, and the State of Florida, their respective officers, agents,

employees, and representatives (“Releasees”) from and against any and all liability for any and all claims, demands,

actions, causes of action of whatever kind or nature, costs and expenses of any nature, including attorneys’ fees

(“Claims”) that I may have or that may hereafter accrue to me, arising out of or related to any harm, loss, damage or

injury, including but not limited to suffering, death or property loss that may be sustained by me, whether caused by

my action or negligence or the action or negligence of Releasees or third parties in connection with the Services. I

also agree not to sue Releasees in connection with any such harm, loss, damage or injury. I agree to indemnify and

hold Releasees harmless from and against all claims asserted against any of the Releases by any entity based upon

my participation in the Services. Notwithstanding the foregoing, nothing herein shall limit or affect my rights to

workers compensation benefits as a volunteer pursuant to Florida law.

I acknowledge and agree that should any provision or aspect of this Release be found to be unenforceable,

all remaining provisions of this Release will remain in full force and effect. Further, I acknowledge and agree that

this Release shall be construed pursuant to the laws of the State of Florida.

I acknowledge and agree that my participation in the Services may cease at any time at my request or at the

request and discretion of the University or the Organization.

I acknowledge and agree that volunteers are not considered employees of the University or the

Organization, but that I am entitled to workers compensation and state liability protection under the same conditions

as state employees in accordance with Chapter 440 and 768.28 of the Florida Statutes.

I have read, understand, and acknowledge each term of this Release and have voluntarily executed this Release.

____________________________________________

___________________________________________

Volunteer’s Signature

Date

Parent/Guardian’s Signature

Date

(I certify that I am 18 years of age or older)

(If Volunteer is under 18 years of age)

Volunteer Waiver (8/7/06)

Volunteer Waiver And Release Form

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