Specialized Needs Recreation

Project Volunteer Agreement

Name:______________________________________________________ Day Phone:________________

Address:____________________________________________________ Evening Phone:_____________

City, State, Zip:______________________________________________ Email: ____________________

Project Location:_____________________________________________ Project Date:________________

In case of emergency, please contact:

Name:_______________________________________________________ Relationship:______________

Day Phone:________________________________ Evening Phone:_______________________________

The undersigned on behalf of themselves and their estate, hereby waives any right of recovery and releases Specialized Needs Recreation, their officers, officials, employees and agents, from liability related to the Undersigned, arising from any and all injury to persons and damage to property, and further agrees and undertakes to indemnify, hold harmless and defend Specialized Needs Recreation from and against any and all claims, damages, actions, liability and expenses including attorney’s fees and other professional fees in connection with bodily injury including death, personal injury and/or damage to property arising from or out of the Undersigned’s activities and participation in volunteer services at the above Specialized Needs Recreation events

The Undersigned further acknowledges and agrees that Specialized Needs Recreation does not assume any responsibility whatsoever for any property of the Undersigned and the Undersigned shall not hold Specialized Needs Recreation liable for any loss or damage to same. The Undersigned gives their permission to be photographed and have their image used in Specialized Needs Recreation.

If during my (or my minor child’s) participation in Specialized Needs Recreation activities I (and/or my minor child’s) should need emergency medical treatment and I (and/or my minor child’s) am (are/is) not able to give my consent or make my own arrangement for that treatment, I authorize Specialized Needs Recreation to take whatever measures are necessary to protect my (and/or my minor child’s) health and well being, including if necessary, hospitalization.

Volunteer Signature:_____________________________________________ Date:___________________

For Youth Under 18 Years of Age

Signature of Guardian:____________________________________________ Date:__________________