VILLAGE OF SUSSEX

Village of Sussex Recreation Department Volunteer Release

This form is to assist the Sussex Parks & Recreation Department in procuring volunteers for various programs, activities and events. Thank you for taking an interest in the programming for the Village of Sussex. The person named on this form wishes to participate in the
2023 Village of Sussex Volunteer Program.

Phone Number

The Village of Sussex and its employees wish to ensure to the fullest extent that they are not sued or held liable for injuries sustained by the volunteers or participants. I make this release and agreement on my behalf and on behalf of anyone who would be able to sue if I were injured while using, attending or participating in activities. In return for being allowed to participate in the 2023 Village of Sussex Volunteer Program,

I agree and acknowledge as follows:

Participation in the 2023 Village of Sussex Volunteer Program carries with it some risk of serious injury, including in rare cases death. The risks included, but are not limited to those cause by over exertion, the equipment, the facilities, staff mistakes and action of other users;
I assume all risk by participating in 2023 Village of Sussex Volunteer Program;
I understand that the Village of Sussex and its employees are relying upon the agreements and representations I herein make;
I release the Village of Sussex and its employees from any and all claims including negligence claims and claims relating to personal injury or property, arising out of my participating in the 2023 Village of Sussex Volunteer Program, except I do not release reckless or intentional tort claims;
I have carefully read this document and understand it. With knowledge of the risks involved and the rights that I give up, I waive the rights I might otherwise have and I freely sign this document.

The undersigned, parent/guardian or a designee do hereby understand that the individual herein to further agree to completely indemnify and hold harmless the Village of Sussex and its employees, officers and agents from and against any and all liability. Furthermore, the individuals named herein are in good physical condition appropriate for the stated activity and the participants assume full responsibility for injuries incurred while taking part in the 2023 Village of Sussex Volunteer Program. No accident insurance is provided by the Village of Sussex. I have read and agree to the related policies, procedures and/or guidelines. By signing this, I agree to comply with the Code of Conduct policy set forth by the Village of Sussex and will accept the ramifications should I not adhere to it.

I am the:

Volunteer Applicant

Parent/Guardian of the a Minor Volunteer Applicant

Parent Guardian Acknowledgement

PARENTAL CONSENT: (To be completed if applicant is under 18 years of age) I give my consent for my child named above to provide volunteer services to the 2023 Village of Sussex Volunteer Program. I also give the Village of Sussex my consent to obtain and emergency medical treatment necessary for the safety of my child. If participant is under 18 years old then: 1.) signature of parent or guardian also required, and 2.) the word “I” used above means “I and my parent/guardian.”)

Signature of Volunteer Applicant/Parent or Guardian

First Name

Last Name

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I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.