Students in Action Volunteer Registration Form

Please fill out a registration form for EACH event/program that you wish to volunteer at. Please contact us at 305-259-1234 if you need any assistance, or if you have any questions. Thank you.

Village of Palmetto Bay - 9705 East Hibiscus Street, Palmetto Bay, FL 33157 (305) 259-1234 www.palmettobay-fl.gov

Applicant Name

Name of Event

Date of Event

Phone

Address

Gender

Male

Female

Date of Birth

Age

School Name

School ID #

Grade

Graduation Month/Year

T-Shirt Size

XXL

Emergency Contact 1

Phone

Relationship

Are you doing community service as a graduation requirement for high school?

Yes

If NO, briefly describe what you need community service hours for in the space provided below.

Village of Palmetto Bay - Waiver & Release Liability Form

Please read each section carefully.

PARTICIPATION: I, the undersigned parent or guardian of my minor child participant, hereby consent for my child to participate in any and all programs sponsored by the Village of Palmetto Bay, Department of Parks and Recreation, and hereby waive, release, absolve, indemnify and agree to hold harmless the Village of Palmetto Bay, and its employees, including persons transporting the participants to and from activities, and any other individual, group, organization or corporation under contract with Village of Palmetto Bay, for any claim arising out of an injury to the participant. I understand that the Village of Palmetto Bay is not responsible for any personal items, etc., lost during this program and I will discourage my child from bringing such items. RELEASE OF ALL CLAIMS: The undersigned, individually and on behalf of the participant, releases, covenants not to sue and forever discharges the Village of Palmetto Bay, its Officers, Agents, Employees, Coaches, and other Volunteers and their successors and assigns (all of whom constitute the released parties) of all liabilities, claims, actions, damages, costs or expenses that the participant may have against the released parties arising out of or in any way connected with participation in the programs/events sponsored by the Department of Parks and Recreation, including travel to and from such events/programs, and including injury or damage to person or property, or resulting in death of the participant, whether caused by the NEGLIGENCE of the released parties or otherwise. CONSENT TO TREATMENT: In the case of an emergency, I authorize the staff of the Village of Palmetto Bay to obtain whatever medical treatment deemed necessary for the welfare of my child. I further understand and agree that I will be financially responsible for all charges and fees incurred in the rendering of said emergency treatment regardless of whether or not my medical insurance would cover such charges and fees. TERMS AND CONDITIONS: Terms and Conditions of Volunteer Participation: Volunteers are not considered employees of the Village of Palmetto Bay. Volunteers do not receive any wages, compensation or other remuneration and are not eligible for any employee benefits from the Village. Volunteer hours may be applied towards community service credits. Volunteers are covered by workers compensation (Chapter 440, Florida Statutes). Volunteers are required to comply with all applicable Village of Palmetto Bay Parks and Recreation policies and rules and the Village reserves the right to terminate the volunteer status of an individual at any time and for any reason. After completion of the activity/activities with the Village of Palmetto Bay Parks & Recreation Volunteer Program, volunteers are required to return all uniforms, ID cards, and other Village-supplied property. PUBLIC RECORD: I, the undersigned parent or guardian, acknowledge and understand that Florida has very broad public record laws. Most written communications to or from local officials regarding official business are public records available to the public and media upon request. Your e-mail may therefore be subject to public disclosure, if requested. I, the undersigned parent or guardian my minor child participant, grants the right for my image or likeness and/or my child's image or likeness to be used for marketing or printing purposes associated with the promotion and marketing of the event, and any news story coverage of Parks and Recreation related activities. I give my permission to the Village of Palmetto Bay for any photos or video footage of myself or child taken during the course of this program to be used for educational, promotional, or any other purpose by the Village of Palmetto Bay. By signing this application I agree to the terms and conditions for volunteer participation with the Village of Palmetto Bay.

Student Volunteer Permission (Required for applicants less than 18 years of age)

Please read and sign below.

Digital Signature