Parks And Recreation Workday Volunteer Application - Broward County
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2BROWARD COUNTY BOARD OF COUNTY COMMISSIONERS
PARKS AND RECREATION DIVISION
WORKDAY VOLUNTEER APPLICATION
NOTE:
WORKDAY VOLUNTEERS COMPLETING THIS FORM ARE ONLY AUTHORIZED TO PARTICIPATE IN ONE
SCHEDULED WORKDAY, WORKDAY SERIES OR ONE-TIME PROJECTS. SUBSEQUENT ONGOING VOLUNTEERING BEYOND
THESE SCHEDULED WORKDAYS WILL REQUIRE THE ENTIRE VOLUNTEER PACKAGE TO BE COMPLETED.
NAME __________________________________________________ DATE OF BIRTH __________________________________
ADDRESS ___________________________________ CITY ___________________________ ST _____ ZIP ________________
HOME PHONE ______________________________________ WORK PHONE ______________________________________
IN CASE OF EMERGENCY CONTACT:
NAME ________________________________________________ RELATIONSHIP ___________________________________
HOME PHONE _____________ WORK PHONE _____________ CELL PHONE _____________ BEEPER _____________
DESCRIPTION OF WORKDAY VOLUNTEER DUTIES:
____________________________________________________________________________________________________________
IF YOU SHOULD REQUIRE ACCOMMODATION TO ANY VOLUNTEER DUTIES DESCRIBED ABOVE DUE TO
FUNCTIONAL LIMITATIONS, PLEASE COMPLETE SECTION BELOW. EXPLANATION OF ACCOMMODATION
REQUIRED:
____________________________________________________________________________________________________________
NOTICE: THIS FORM CONTAINS A RELEASE, INDEMNITY AND WAIVER OF LIABILITY IN FAVOR OF
BROWARD COUNTY. WHEN SIGNED, THIS FORM IS A CONTRACT WITH LEGAL CONSEQUENCES. PLEASE
READ IT CAREFULLY BEFORE SIGNING.
I am a workday volunteer for Broward County. I have read and understand the above description of my responsibilities as a volunteer
and agree to remain within the scope of those responsibilities while volunteering with the Parks and Recreation Division of Broward
County. I have no known health problems that would hinder or be aggravated by my participation in this program. I do hereby agree to
release, waive, discharge, and covenant not to sue Broward County, its officers, agents, and employees, from any and all liability or
claims for damage or injury that may be sustained by me directly or indirectly in connection with, or arising out of my volunteer activities
noted above, whether caused in whole or in part by the negligence of Broward County. I, further agree, to indemnify and hold
harmless Broward County with respect to any and all liability, including all fees, costs, expenses, and attorney’s fees, resulting from
losses sustained by third parties, arising out of my actions or alleged actions in connection with my volunteer duties described herein.
I, on behalf of myself, or as parent/guardian of the dependent named herein, do hereby grant full permission to Broward County to use
photographs, videotapes, recordings, and any other record of the activity for any legitimate purpose whatsoever.
VOLUNTEER SIGNATURE ________________________________________ DATE __________________________________
NOTE: SIGNATURE OF PARENT/LEGAL GUARDIAN IS REQUIRED FOR VOLUNTEERS UNDER 18 YRS. OF AGE
PARENT/LEGAL GUARDIAN SIGNATURE ________________________________________
DATE ___________________
NOTE: THIS IS A TWO-SIDED FORM THAT MUST BE REVIEWED, DATED AND SIGNED.
******************************************************************************************
FOR DIVISION USE (MUST BE COMPLETED BY SITE)
SITE ____________________ SITE COORDINATOR ______________________ EVENT DATE (S)____________________
PLEASE FORWARD ORIGINAL COMPLETED WORKDAY VOLUNTEER APPLICATION TO THE VOLUNTEER/
TH
COMMUNITY SERVICE WORKER COORDINATOR, PARKS AND RECREATION DIVISION, 950 N.W. 38
ST.,
OAKLAND PARK, FL
Form 501-207 Workday Volunteer Application (04/10)
Page 1
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