Volunteer Sign Up 

2. Contact Information
4. First Name*
5. Last Name*
7. Address1*
9. Address2
11. City*
12. State*
13. Zip*
15. Phone Number*
16. Email Address
18. Emergency Contact
20. First Name
21. Last Name
23. Phone Number
25. Volunteer Information
27. Name of event you are volunteering for?*
29. Date of the event?*
    Date of the event?
31. How many hours are you interested in volunteering for this event?*
33. Would you like to receive email notifications about volunteer opportunities?

    1. Yes
    2. No
35. Would you like to receive Friday News updates with timely information about happenings in Mendota Heights?

    1. Yes
    2. No
37. Volunteer Waiver

    I understand and acknowledge that participation in any Activity is voluntary. I acknowledge that participation in the Activity has certain risks that cannot be eliminated regardless of the care taken to avoid injuries. Such risks may include, but are not limited to, minor injuries such as bruises and sprains; major injuries such as joint or back injuries, head injuries and broken bones; and catastrophic injuries including paralysis and death. I understand these risks known or unknown, anticipated or unanticipated may result in injury, death, illness, disease including exposure to COVID-19 or damage to myself or my property, or to other persons and their property. 

    In consideration of being allowed to participate in the Activity, I hereby knowingly and freely assume any and all risks, both known and unknown, in connection with this Activity. I hereby agree to hold the City, its officials, employees, agents and contractors harmless and I waive any right to make claims or bring lawsuits against the City or anyone working on behalf of the City for any injuries or damages related to the alleged negligence of the City. 

    I agree to defend, indemnify and hold harmless the City for any expense or liability the City may incur as a result of my conduct, actions or omissions while participating in or performing the Activity. This waiver of liability does not waive liability for injuries or damages that are the result of any willful, wanton, or intentional misconduct by the City or any person acting on behalf of the City. The terms of this agreement shall bind the members of my family, if I am alive, and my heirs, assigns and personal representatives if I am deceased. 

    I acknowledge that COVID-19 has been declared a worldwide pandemic by the World Health Organization. COVID19 is extremely contagious and is believed to spread mainly from person-to-person contact. The City has enacted preventative measures to reduce the spread of COVID-19. The City, however, cannot guarantee that participants in the Activity will not become infected with COVID-19. I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk I may be exposed to or infected by COVID-19 by participating in the Activity. 

    To the best of my knowledge I have no physical or medical condition that would prevent me from participating in the Activity. I warrant that I do not have any symptoms of COVID-19, including, without limitation, fever, cough, shortness of breath or difficulty breathing, chills, or muscle or body aches; or have a suspected or confirmed diagnosis of COVID-19. 

    I agree to comply with all rules related to the Activity including policies related to social distancing and personal hygiene to help prevent the transmission of COVID-19. If I observe any unusual or significant hazard during my participation in the Activity, I will stop participating and immediately notify the nearest official. 

    I grant and convey to the City of Mendota Heights all right, title, and interest in any and all photographs, images, video, digital media, or audio recordings of me or my likeness or that of my child made by the City of Mendota Heights in connection with my participation in the Activity. 

    I acknowledge that if I or my child has special needs, it is my responsibility to notify the Volunteer Program Coordinator, 651-452-1850 so that arrangements can be made prior to the start of the volunteer event. 

    I understand that if any court finds any portion of this Waiver, Release and Indemnification Agreement to be contrary to law, invalid, or unenforceable, the remainder of the Waiver, Release and Indemnification Agreement will remain in full force and effect. 

    I HAVE READ THE ABOVE AND UNDERSTAND THE LEGAL SIGNIFICANCE OF SIGNING THIS DOCUMENT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. 

    NOTICE: Participants under 18 years of age must have this Waiver, Release and Indemnification Agreement signed by their parent or guardian. 

    I certify that I am the parent or legal guardian of the above individual and hereby consent to his or her participation in the Activity. I have read and understand the above Waiver, Release and Indemnification Agreement and I agree to be bound by the terms stated therein.

    By typing your name below and submitting this form, you are indicating your agreement with the terms outlined in the waiver.

39. Full Name
40. Date and Time
    Date and Time

    Date and Time
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42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit Submit and Print

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