City Of White House Volunteer Application Form (Page 2 of 2) in pdf

* Volunteers under the age of 18 must have parental consent. All legal guardians must sign/initial

application form accordingly.

Authorization/Agreement:

By my signature below I certify that all of the information and statements provided by me in and

with this application are true and correct. It is understood and agreed upon that any

misrepresentation or omission by me in this application will be sufficient cause for cancellation of

this application and forfeiture of my opportunity to volunteer with the City of White House. ____

Initial

Release of Liability:

In consideration of being allowed to participate as Volunteer for the City of White House, I

acknowledge that working on municipal projects may be unintentional hazardous activities and I

assume all risks associated with this volunteer opportunity. I waive all claims for damages against

the city and against its officers and employees for injury to my person or property, including death

and destruction that may arise from activities. I further understand that I am working as a

volunteer, not an employee, and I am not entitled to any compensation for the volunteer activities I

perform. I release the city and its officers and employees and agree to hold them harmless from

any such liability. _____

initial

____________________________________

_____________________

Volunteer Signature

Date

Parental Consent and Release of Liability: (If applicable)

In consideration of our child, __________________________________, being allowed to participate

in a Volunteer capacity for the City of White House, we acknowledge that working on municipal

projects may be unintentionally hazardous. Nevertheless, we grant permission for our child to

participate in this activity and assume all the risks associated with this work. We waive all claims

for property, including death and destruction and resulting injuries and damages that may arise

from this activity. We further understand that our child is working as a volunteer, not an employee,

and is not entitled to any compensation for the volunteer activities he/she performs. We release

the city and its officers and employees and agree to hold them harmless from any such liability.

This agreement shall remain in force until we revoke it in writing.

___________________________________

____________________________________

Parent or Guardian Signature

___________________________________

_____________________________________

Print Name

Date

Print Name

Date

City Of White House Volunteer Application Form Page 2