Volunteer Liability Release

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W

S

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ATERSHED

TEWARDS

ROGRAM

OLUNTEER

IABILITY

ELEASE

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_______________________________________ M

________________________________________ D

___________

AME OF

VENT

EMBERS

ATE

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P

R

:

By signing below, I release Watershed Stewards Program and California Conservation Corps of all liability from any harm or injury to my

IABILITY AND

UBLICITY

ELEASE

person and property resulting from my participation in this volunteer activity, I understand that my participation in any activity is fully voluntary. I am responsible for my own safety

and well-being and for obtaining all safety information related to any activity I participate in. By signing below, I hereby authorize the Watershed Stewards Program and the

California Conservation Corps to use photographs or other media material pertaining for the express purposes of publicity and documentation. I agree that while transported in WSP

or CCC owned or operated vehicles, I will conform to all federal, state, and CCC policies, procedures, rules, regulations, directives and instructions. This includes, but is not limited

to, the proper use of seatbelts and not extending limbs or throwing objects in or from the vehicle. I agree to hold harmless the CCC and WSP for any injuries sustained while being

transported in said vehicles unless otherwise found by a court of law to be caused by the negligence of a CCC or WSP employee.

E

M

I

:

If you have any allergies or medical conditions, please let the site coordinator know in case of emergency.

MERGENCY

EDICAL

NFORMATION

1.

Print Name LEGIBLY!

Email

Signature:

Emergency Contact Name:

Emergency Contact Phone:

Have you ever volunteered with the WSP before? Y/N

If so, how many times? ________

2.

Print Name LEGIBLY!

Email

Signature:

Emergency Contact Name:

Emergency Contact Phone:

Have you ever volunteered with the WSP before? Y/N

If so, how many times? ________

3.

Print Name LEGIBLY!

Email

Signature:

Emergency Contact Name:

Emergency Contact Phone:

Have you ever volunteered with the WSP before? Y/N

If so, how many times? ________

4.

Print Name LEGIBLY!

Email

Signature:

Emergency Contact Name:

Emergency Contact Phone:

Have you ever volunteered with the WSP before? Y/N

If so, how many times? ________

5.

Print Name LEGIBLY!

Email

Signature:

Emergency Contact Name:

Emergency Contact Phone:

Have you ever volunteered with the WSP before? Y/N

If so, how many times? ________

F

WSP

,

F

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