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Citizens for a walkable &bikeable Carson city


Carson City Parks & Recreation Department

Nevada Day Trash Mob

October 27th, 2019

Thank you for volunteering your time with Carson City!

RELEASE, INDEMNIFICATION, AND ASSUMPTION OF RISK

PLEASE READ CAREFULLY

1. I understand that my participation in the City of Carson City (“City”) programs, operations, and/or

maintenance is a voluntary activity, and that I am donating my time and my labor by my own free

choice. I agree to perform my assigned tasks in a safe and responsible manner.


2. Photographic Release: Volunteer does grant and convey unto the City all rights, title, and interest

in any and all photographic images or video or audio recordings made by the City during the

Volunteer’s activities with the City.


3. Indemnification: In consideration of being allowed to participate in volunteer activities, the

undersigned volunteer (and his or her parent(s) or legal guardian(s) if the volunteer is a minor)

agree(s) to indemnify and hold harmless the City, its officers, agents and employees, against any

and all liability, claims, and demands, on account of injury, loss, or damage, including without

limitation claims arising from bodily injury, sickness, disease, death, property loss or damage, or

any other loss of any kind whatsoever, which arise out of or are in any manner connected with the

below-described activities or volunteer assignment, if such injury, loss or damage is caused in

whole or in part by, or is claimed to be caused in whole or in part by the act, omission, negligence,

or other fault on the part of the volunteer. The volunteer understands that the City does not carry or

maintain health, medical, or disability insurance for any volunteer.


4. Assumption of Risk: Volunteer (and his or her parent(s) or legal guardian(s) if the volunteer is a

minor) agree(s) and understand(s) that the below-described activities or volunteer assignment may

involve risks of injury, loss, or damage to the volunteer, including but not limited to bodily injury,

sickness, disease, death and property loss or damage. By signing this agreement, volunteer (and his

or her parent(s) or legal guardian(s) if the volunteer is a minor) expressly agree(s) to assume any

and all such risks. In addition, in consideration for being permitted to perform the below-described

activities or volunteer assignment, volunteer (and his or her parent(s) or legal guardian(s) if the

volunteer is a minor) hereby expressly exempt(s) and release(s) the City, its officers, agents and

employees from and against all liability, claims, and demands, on account of injury, personal injury,

sickness, disease, death, or property loss or damage, that the volunteer may incur as a result of

being upon the premises of the City, or as a result of performing the below described activities or

volunteer assignment, whether any such liability, claims, and demands result from the act,

omission, negligence, or other fault on the part of the City, its officers, agents and employees, or

from any other cause whatsoever.


5. Description of volunteer assignment: _

Trash mob clean-up after Nevada Day downtown.


6. I am the volunteer and am over 18 years of age. I acknowledge that I have carefully read and I

understand this RELEASE, INDEMNIFICATION, AND ASSUMPTION OF RISK. By my

signature, I agree to be bound by and responsible for all the provisions of this two page document,

on behalf of myself, my successors, representatives, heirs, executors, assigns, and transferees of

myself.


Printed Name: _____________________________________________________

Signature __________________________________________________________

Date ____________________

Address: ___________________________________________________________________________

Phone Number: ____________________

Email: ___________________________

Emergency Contact – Name ____________________________Phone: ___________________

Relation to emergency contact person:______________________

-------------------------------------------------------------------------------------------------------------------------------

7. If volunteer is under 18 years of age each parent/legal guardian must complete the following:

I am/we are the parent(s)/legal guardian(s) of the minor volunteer. I acknowledge that I have

carefully read and I understand this RELEASE, INDEMNIFICATION, AND ASSUMPTION OF RISK,

and by my/our signature(s), agree to be bound by and responsible for all its provisions on behalf of

ourselves, the minor volunteer, and the successors, representatives, heirs, executors, assigns, and

transferees of ourselves and the minor volunteer. I/we consent to the minor volunteer’s participation in the

above-described volunteer assignment or activities.

Name of Minor Volunteer: ______________________ Age: ___________

Printed Name of Parent or Guardian ___________________________________

Parent or Legal Guardian’s Signature ___________________________________

Dated ____________

Printed Name of Parent or Guardian ___________________________________

Parent or Legal Guardian’s Signature ___________________________________

Dated _____________

Address: ___________________________________________________________________________

Phone Number: ____________________

Email: ___________________________

Emergency Contact – Name ____________________________Phone: _________________________

Relation to emergency contact person if other than parent or guardian:______________________




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