Volunteer Waiver Form

Volunteer Waiver Form

  • (“Volunteer”).
  • PURPOSE: The purpose of this Agreement is to outline the responsibilities of the City in providing volunteer opportunities, and to create an understanding between the City and the Volunteer.

    This Agreement shall apply to persons voluntarily performing non‐compensated services for the City, including but not limited to, non‐compensated practical work experience, recreational programs, cleanup initiatives, academic internships, and any other type of volunteer activities.

    AGREEMENT FOR NON‐COMPENSATED SERVICES: The Volunteer agrees to abide by the information contained in the City of Gary Personnel Manual. The Volunteer agrees to perform the volunteer services in a safe, responsible manner in accordance with the description of work. The City shall not be responsible for, nor liable for, nor shall the applicant be eligible to receive, any compensation or benefits as a result of this Agreement.

    In consideration of the City giving me permission to perform these volunteer services, I understand that:

  • TERMINATION: I understand that this Agreement may be terminated by either party upon written notice by either party, and that I am volunteering my services at will and may be asked to discontinue such without prior notice or reason.

    WAIVER AND HOLD HARMLESS: I am fully aware that the work associated with being a City Volunteer involves certain risks of physical injury or death. Being fully informed as to these risks and in consideration of my being allowed to participate in the City’s Volunteer Program, I hereby assume all risk of injury, damage and harm to myself arising from such activities or use of City facilities. I also hereby individually and on behalf of my heirs, executors and assignees, indemnify and hold harmless the City, its officials, employees and agents and release and waive any right of recovery I might have to bring a claim or a lawsuit against them for any personal injury, death, or other consequences occurring to me arising out of my volunteer activities.

    LIABILITY COVERAGE: I understand that the City is self‐insured for liability coverage. However, volunteers performing within the scope of their assigned duties as authorized by the City are afforded the same coverage as City employees. I am fully aware my intentional misconduct or gross negligence as a volunteer is not protected or covered by the City. I expressly agree this liability waiver is intended to be broad and inclusive as is permitted by Indiana law, and if any portion is later held invalid, the balance will continue in full legal effect and force.

  • Date Format: MM slash DD slash YYYY
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  • If under eighteen years of age, consent must be given by:

  • Date Format: MM slash DD slash YYYY
  • EMERGENCY CONTACT:

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