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Volunteer Waiver of Liability

Steps

1. Step One This section is complete This section is incomplete
2. Waiver of Liability This section is complete This section is incomplete
3. Acknowledgment/Signature This section is complete This section is incomplete

Step One

Volunteer Waiver of Liability
The waiver below is required for any volunteer opportunity with the Town of Northlake.
First Name (Volunteer)*
Last Name (Volunteer)*
Volunteer Age:*
First Name (If Volunteer Under 18 - Name of Parent/Guardian)
Last Name (If Volunteer Under 18 - Name of Parent/Guardian)
Address*
City*
State*
Zip Code*
Home Phone*
Work Phone
Email Address*
Explain the type of volunteer activity to be conducted:*
Dates of Project:*
Dates of Project:
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Waiver of Liability

NOTICE: THE TOWN OF NORTHLAKE DOES NOT COVER VOLUNTEERS UNDER THE TOWN OF NORTHLAKE WORKERS’ COMPENSATION INSURANCE.
IN CONSIDERATION OF THE TOWN OF NORTHLAKE ALLOWING ME (MY CHILD/CHILDREN) TO PARTICIPATE AS A TOWN OF NORTHLAKE VOLUNTEER, AND BEING AWARE OF THE POSSIBLE INJURIES THAT COULD OCCUR AS A RESULT OF THAT PARTICIPATION, I ON BEHALF OF MYSELF (MY MINOR CHILD/CHILDREN) RELEASE THE TOWN OF NORTHLAKE, ITS ELECTED AND APPOINTED OFFICIALS, EMPLOYEES, AGENTS, INSTRUCTORS FROM ANY AND ALL INJURIES AND DAMAGES WHATSOEVER ARISING FROM PARTICIPATION IN ANY VOLUNTEER ACTIVITY OR EVENT.
I, MY HEIRS AND REPRESENTATIVE, AGREE TO INDEMNIFY, SAVE AND HOLD HARMLESS THE TOWN OF NORTHLAKE, ITS ELECTED AND APPOINTED OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND ALL CLAIMS MADE BY ME (MY CHILD/CHILDREN) OR MY INSURER FOR INJURIES OR DAMAGES RELATED TO ANY VOLUNTEER ACTIVITY OR EVENT.
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Acknowledgment/Signature

Acknowledgement *
By acknowledging below, I understand the following:
1. This waiver is subject to release pursuant to the Texas Public Information Act.
2. I confirm I have read the waiver and agree to the provisions included.
3. I further attest that all information contained in the application is true and correct.
1. I Agree
Signature: *Type your full name as listed on this application.*
If under 18 - Parent or Guardian Signature Required.

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Email address

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Volunteer Waiver of Liability

Steps

Step One

Waiver of Liability

Acknowledgment/Signature

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