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Required fields are marked with an asterisk (*). One of the fields below is a file upload/attachment, the file size must be less than 10MB.
First Name *
Last Name *
Home Address Street *
City *
State *
Zip Code *
Mobile Phone *

For example, 123-456-7890
SMS (text) messaging:
You may opt-in to receive SMS (text) for Pleasant Valley Recreation & Park District volunteer activities, including shift reminders and cancellations.

To opt-out, reply STOP to any SMS message OR update the SMS opt-in setting in your profile.
Age *
Parent/Legal Guardian Name *
Date of Birth *

A valid date as MM/DD/YYYY (for example: 11/30/2015)
Are you part of a group? *
Group Name *
Please indicate group name
How did you hear about our volunteer program? *









Why do you want to volunteer for Pleasant Valley Recreation and Park District? *


Do you have volunteer experience? *
Where and what type of work did you perform? *
Emergency Contact Name (if a minor, list parent/guardian) *
Emergency Contact Mobile Phone *
Relationship to you *

Waiver

PLEASANT VALLEY RECREATION AND PARK DISTRICT | VOLUNTEER AGREEMENT, WAIVER, AND RELEASE | INFORMATION TO PARTICIPANT REGARDING RISK OF INJURY

Any and all recreation activities involve the risk of injury. You, as the participant, must be aware of the particular risks involved in the activity you have signed up for. For example, a softball player runs the risk of breaking an arm while diving for a ball or being struck by a thrown ball; a calligraphy student may fall and break a bone while walking out of class or to their chair; an excursion participant may trip and fall from the bus or the bus itself may be involved in an accident. In any event, participants must understand that all activities have the potential for an injury and {District Name} is not liable. Participants must understand and agree that they take part in the activity at their own risk.

In consideration for being permitted by the District to participate in the above-referenced activity, I hereby waive, release, and discharge any and all claims for damages for personal injury, death, or property damage which I may have, or which may hereafter accrue to me, as a result of participation in said activity. This release is intended to discharge in advance the District (including its officers, employees, volunteers, and agents) from any and all liability arising out of or connected in any way with my participation in said activity, even though that liability may arise out of active or passive negligence or carelessness on the part of the persons or entities mentioned above.

It is further agreed that this waiver, release, and assumption of risk is to be binding on my heirs, administrators, executors, and assigns and that I shall indemnify and hold the District (including its officers, employees, volunteers, and agents) free and harmless from any loss, liability, damage, cost, or expense which may arise out of or connected in any way with my participation in said activity.

Additionally, I fully understand that my participation in the above-referenced activity exposes me to the risk of personal injury, death, communicable diseases, illnesses, viruses, and/or property damage. I hereby acknowledge that I am voluntarily participating in this activity and agree to assume any such risks.

PHOTOGRAPHIC RELEASE: I understand that photographs may be taken during this activity and hereby grant the District permission to use any such photo(s) for advertising or in promotional materials.

PARENTAL/GUARDIAN CONSENT: (to be completed and signed by parent/guardian if Participant is under 18 years of age.)

I hereby consent that my son/daughter participate as a volunteer in the above-referenced activity, and I hereby execute the above Agreement, Waiver, and Release on his/her behalf. I state that said minor is physically able to participate in said activity. I hereby agree to indemnify and hold the District (including its officers, employees, volunteers, and agents) free and harmless from any loss, liability, damage, cost, or expense which may arise out of or connected in any way with said minor’s participation in said activity.

I HAVE CAREFULLY READ THIS AGREEMENT, WAIVER, AND RELEASE AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN MYSELF AND THE ABOVE DISTRICT AND I SIGN IT OF MY FREE WILL.