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Volunteer’s Agreement and Release from Liability
1. Voluntary Participation. I acknowledge that I have voluntarily applied to assist Keep Stamford Beautiful with their project (the "Project"). I understand that the Project is scheduled to occur on (date); however, the date may be changed or the Project canceled in the sole discretion of the Project. I understand that as a volunteer, I will not be paid for my services; that I will not be covered by any medical or other insurance coverage provided by the Project; and that I will not be eligible for any Workers Compensation benefits. I further agree that my participation in the Project may be terminated at any time by either the Project or me. 2. Assumption of Risk. I AM AWARE THAT, IN PARTICIPATING IN THIS PROJECT, I MAY BE EXPOSED TO PERSONAL INJURY OR DAMAGE TO MY PROPERTY AS A RESULT OF MY ACTIVITIES, THE ACTIVITIES OF OTHER VOLUNTEERS, OR THE CONDITIONS UNDER WHICH VOLUNTEER SERVICES ARE PERFORMED. WITH KNOWLEDGE OF THESE DANGERS, I AGREE TO ACCEPT ANY AND ALL RISKS OF PERSONAL INJURY OR DEATH. 3. Release. In consideration for the opportunity afforded me to participate in this Project, I hereby agree that I, my assignees, heirs, guardians and legal representatives will not make a claim against the Project, the businesses, residents and community services agencies which have organized the project, or their officers, directors, or any supplier of materials or equipment that is used by the Project, or any of the volunteers, for injury, damage or death resulting from the negligent acts or omissions of any person or entity, however caused, arising from or related to my participation in the Project. Without limiting the generality of the foregoing, I hereby waive and release any rights, actions or causes of action resulting from personal injury or death to me, or damage to my property, sustained in connection with my participation in the Project; provided, however, that the loss or damage was not caused by an act or omission that was reckless, wanton, intentional, or grossly negligent. I further consent to the unrestricted use by the Project and/or any person authorized by it of any photographs, recordings, interviews, videotapes, motion pictures or similar visual or auditory recordings of me in connection with the Project. The undersigned agrees to hold harmless the owner of the property where refuse containers are located. 4. Knowing and Voluntary Execution. I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN MYSELF AND THE PROJECT AND SIGN IT OF MY OWN FREE WILL. I CERTIFY THAT I AM AT LEAST EIGHTEEN YEARS OF AGE OR HAVE DELIVERED THE CONSENT OF MY PARENT OR GUARDIAN TO THE PROJECT. Executed at______________________, Connecticut on _______________________, 200 .
Volunteer / Parent signature: __________________________________________ Volunteer / Parent name printed:__________________________________________ Address: __________________________________________ __________________________________________ Phone: __________________________________________ Child’s signature: __________________________________________ Emergency contact and phone number:
_____________________________________________________________________________ I certify that ________________________________ acknowledged in my presence that he/she had read and full understood the meaning and consequences of the foregoing RELEASE, and signed it in my presence.
By_____________________________________ Project Coordinator
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