| Last Name: * |
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| First Name: * |
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| M.I. |
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| Home Address: * |
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| City: * |
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| State: * |
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| Zip: * |
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| Social Security #: * |
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| Birthdate: * |
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| Phone: * |
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| Volunteer Preference * |
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I hereby agree to volunteer for the “3 for 3” Triathlon (the “Organization”). I acknowledge that there are inherent risks in participating in some of the activities of the Organization as a volunteer and that I am volunteering at my own request and at my own risk. The risks include, but are not limited to, those caused by terrain, facilities, temperature, weather, equipment, vehicular traffic, lack of hydration, and actions of other people including, but not limited to, participants, other volunteers, spectators, coaches, event officials, and directors of the “3 for 3” Event. I realize that liability may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained or controlled by them, or because of their possible liability without fault. I hereby assume all of the risks of participating and/or volunteering for this Organization. (Initial in Box below) *
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I acknowledge that this Volunteer Waiver and Release of Liability form will be used by the Organization, event sponsors, and event directors and that it will govern my actions and responsibilities at and with respect to my participation at the Organization’s events. In consideration of my application and permitting me to volunteer for the Organization, I hereby take action for myself, my executors, administrators, heirs, successors, and assigns as follows: (A) Waive, release, ad discharge from any and all liability for my death, disability, personal injury, property damage, property theft or actions of any kind which may hereafter accrue to me including my traveling to and from the Organization’s events and activities, and the following entities or persons: Alcohol & Addictions Resource Center, Center for the Homeless and the Young Men’s Christian Association of Michiana, Inc., their officers, employees, volunteers, representatives, and agents, the event sponsors, event directors, and event volunteers; (B) Indemnify and hold harmless the entities or persons mentioned in this paragraph from any and all liability or claims made as a result of my participation in the Organization’s events or activities, whether resulting from the negligence, omissions, or admissions of the aforementioned entities or persons, or arising out of or resulting from, directly Volunteer Waiver and Release of Liability. (Initial in Box below) *
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I understand that at Organization events and activities, I may be photographed and/or filmed. I agree to allow my name, voice, photo, video, or likeness relating to my participation with the Organization to be used for any legitimate purpose by event holders, sponsors, organizers, and/or assigns, and I waive all copyrights, rights of publicity or privacy and rights to any compensation in perpetuity to which I may otherwise be entitled as a result of the use of my name, voice, photo, video, and/or likeness. (Initial Box) *
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This Volunteer Waiver and Release of Liability shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law. All individuals over the age of 18 seeking to volunteer for the “3 for 3” will be required to submit the consent form below. By signing this form, you give your permission for the ”3 for 3” sponsors to request a criminal history file search including felony convictions, alcohol/drug related convictions and incidents of child abuse/sexual abuse. You complete this form with the understanding that such information as received by the organization will be used in the processing of your volunteer application. You also agree to waive, release and surrender any and all rights to claims, which you may have against the law enforcement entity releasing the records, or any of its officers or employees as a result of the release of such records. I hereby certify that I have fully read this document, and I understand it content. (My typed name serves as my signature.) *
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| Print Volunteer Name: * |
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| Age: * |
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| Today's Date * |
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| *REQUIRED: I agree to the above terms and conditions. (Initial) * |
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The undersigned parent and natural guardian or legal guardian does hereby represent that he/she is, in fact, acting in such capacity and agrees to save and hold harmless and indemnify each and all of the parties referred to above from all liability, loss, cost, claim, or damage whatsoever which may be imposed upon said parties because of any defect in or lack of such capacity to so act and release said parties on behalf of the minor and the parents or legal guardians.**If Volunteer is under 18 years old, Parent or Guardian must also sign below.
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Print Parent or Guardian Name: (My typed name serves as my signature)
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| Age: |
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| Today's Date: |
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