Rancho Simi Recreation and Park District

Volunteer Program Release and Waiver Form

 

I, __________________________________(FULL NAME OF VOLUNTEER), certify that all statements provided in my online application for Rancho Simi Recreation and Park District’s (the “District”) Volunteer Program (the “Program”) are true, correct and complete to the best of my knowledge.

I understand and agree that my participation in the Program may expose me to the risk of personal injury, death or property damage and I hereby agree to assume any such risks.  I hereby release and waive all claims against the  District for any injury, illness, viruses, death or damage to or loss of personal property arising out of, or in connection with, my participation in Program from whatever cause, including, but not limited to, the negligence or other wrongful conduct of the District or any other participants in the Program.   

Parent/Guardian Consent:  I hereby consent that my child named above may participate in programs and activities coordinated through the  District’s Volunteer Program and consent of behalf of my child to the terms of this Waiver and Release Form.  Said minor is physically able to participate in said activity/assignment.

I HAVE CAREFULLY READ THIS VOLUNTEER PROGRAM RELEASE AND WAIVER FORM AND FULLY UNDERSTAND ITS CONTENTS.  I AM AWARE THAT IT IS A FULL RELEASE OF ANY AND ALL LIABILITY OF THE DISTRICT AND SIGN IT OF MY OWN FREE WILL.

 

_________________________________________             Date:   _____________________________

Signature of Volunteer   

 

Print Name:   ______________________________

 

 

_________________________________________

Signature of Parent (If Volunteer a minor)                              Date:   ____________________________

Print Name:  ______________________________