Eagle Mountain City Volunteer FOrm

Parent Name*

First NameLast Name

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Volunteer Name*

First NameLast Name

Specific Event you are Voilunteering for?

As a volunteer worker:

I will complete assignments to the best of my ability.
I will observe all staff rules and policies, accept supervision, and give my supervisor adequate notice before terminating my volunteer services.
I agree to grant permission to Eagle Mountain City to reproduce and publicize pictures and/or news articles pertaining to my services to or interest in the Eagle Mountain City Volunteer Program.
I understand that in the event I am injured while performing my assignments as a volunteer, I am entitled to Workers Compensation, but for medical benefits only.
I understand that the City has the right, should this job assignment or my performance be inappropriate, to suggest alternative placement or terminate my volunteer services.
I understand that I will receive no monetary compensation for this volunteer service.

Waiver:

I acknowledge and fully understand that there is an inherent risk of serious injury, permanent disability, or death in THE activity that might result from my own actions, inactions, or negligence; the actions, inaction, or negligence of others; or the conditions of others the premises OR EQUIPMENT. I, for myself, and/or a parent, legal (court-appointed) guardian or custodian, knowingly and freely accept and assume all risks, both known and unknown, and AGREE TO RELEASE, DEFEND, INDEMNIFY, NOT SUE AND HOLD HARMLESS EAGLE MOUNTAIN CITY, ITS ELECTED OFFICIALS, OFFICERS, employees, affiliates, volunteers, vendors, equipment manufacturers, sponsors, agents, and other participants, from any claims, damages, (including medical expenses and attorneys’ fees), injuries ( including disabilities, paralysis, and death) and or damages to person or expenses arising out of, or resulting from my voluntary attendance/participation at THE ACTIVITY LISTED ABOVE, or the voluntary attendance/ participation of those for whom I have signed below

IN THE EVENT THAT I OR MY DEPENDENT IS INJURED IN THE ABOVE ACTIVITY, I HEREBY GIVE MY PERMISSION TO EAGLE MOUNTAIN CITY OR ITS REPRESENTATIVE AT THE SCENE TO PROVIDE EMERGENCY MEDICAL TREATMENT BY ANY MEDICAL PERSONNEL, EMTS, PARAMEDICS, FIREFIGHTERS, NURSES, DOCTORS, OR DENTISTS DEEMED NECESSARY. I WILL NOTIFY THE MEDICAL PERSONNEL, IF ABLE, OF ANY SPECIAL MEDICAL NEED(S), INCLUDING BUT NOT LIMITED TO BLOOD TYPES, HEART CONDITIONS, ALLERGIES, OR SPECIAL MEDICINES THAT MIGHT AFFECT MY TREATMENT. I ALSO AUTHORIZE FOR DEPENDENT OR MYSELF TO BE TRANSPORTED BY AMBULANCE TO THE NEAREST MEDICAL FACILITY TO SECURE THE IMMEDIATE AND PROPER MEDICAL TREATMENT. I AGREE THAT I WILL BE THE PRIMARY PARTY FINANCIALLY RESPONSIBLE FOR THE PAYMENT OF ALL COSTS RELATED TO SUCH EMERGENCY TRANSPORT OR SUBSEQUENT MEDICAL TREATMENT.

I ALSO GRANT FULL PERMISSION TO EAGLE MOUNTAIN CITY, SPONSORS OF THE EVENTS, ITS AGENTS, OR ASSIGNEES TO USE MY NAME, PHOTOGRAPHS, VIDEOTAPES, OR RECORDING OF THE ACTIVITY FOR WHICH DEPENDENT OR I AM REGISTERED FOR ANY PURPOSE WITH OBLIGATION OR LIABILITY.

Eagle Mountain City Events Volunteer Form