CONSENT FOR PARTICIPATION AS A VOLUNTEER IN ACTIVITIES SUPERVISED BY THE NORTHBRIDGE PLAYGROUND & RECREATION COMMISSION

 

 

***Please read this document thoroughly before completing and signing***

 

            Participation in volunteer programs and activities can involve certain risks and exposure to injury.  The attached Consent, Release from Liability and Indemnity Agreement is a requirement for participation as a volunteer in programs and/or activities supervised by the Northbridge Playground & Recreation Commission.  It releases the Town, the Department, and their employees from liability or responsibility for any harm or injuries that may result from participation in such programs and activities.  It also provides that the Town will not be liable or responsible for harm to others resulting from participation in such programs and activities.

 

            Please consult with an attorney if you have any questions regarding this document.

 

Participant’s Information:

 

Name:                                                                                                                        

 

Address:                                                                                                                    

 

Date of Birth:                                                                                                            

 

Type of Activity/Program:                                                                                        

 

I agree to participate in volunteer programs and activities supervised by the Northbridge Playground & Recreation Commission and I release the Town of Northbridge, its Playground & Recreation Commission and their employees from liability for any injuries or property damage that may result from my participation.

 

                                                                                   

                                                                                    Signature of Participant

 

Parent/Guardian:                                                        Telephone:                                       

 

Parent/Guardian:                                                        Telephone:                                       

 

 

Emergency Contact:

 

Name:                                                                        

 

Telephone:                                                                

 

 

 

PARENTAL CONSENT, RELEASE FROM LIABILITY

AND INDEMNITY AGREEMENT

 

 

I/we the undersigned “Parent(s)” or “Guardian(s)” of                                                                , a minor, do hereby consent to his/her participation in volunteer activities and programs supervised by the Northbridge Playground & Recreation Commission, and furthermore I/we do forever RELEASE, acquit, discharge and covenant to hold harmless the Town of Northbridge, a municipal corporation of the Commonwealth of Massachusetts, and its successors, departments, officers, employees, servants, and agents, of and from any and all claims, causes of action, expenses and compensation on account of or in any way arising out of, directly or indirectly, all known and unknown bodily injuries or property damage which I/we may now or hereafter have as the parent(s) or guardian(s) of said minor, and also all claims or rights of action for damages which said minor has or hereafter may acquire, either before or after he/she reaches his/her majority, resulting from said minor’s participation in the aforementioned activities and programs of the Northbridge Playground & Recreation Commission.  Furthermore, I/we hereby agree to protect the Town of Northbridge and its successors, departments, officers, employees, servants and agents against any claim for damages, compensation or otherwise on the part of                                                                   a minor, arising out of or resulting from bodily injury to said minor or property damage in connection with said minor’s participation in the aforementioned activities or programs of the Northbridge Playground & Recreation Commission, and to INDEMNIFY, reimburse or make good to the Town of Northbridge or its successors, departments, officers, employees, servants and agents any loss or damage or costs, including attorneys’ fees, the Town of Northbridge or its representatives may have to pay if any claim or litigation arises from said minor’s participation in the aforementioned activities or programs of the Northbridge Playground & Recreation Commission or the administration of first aid to said minor.

 

 

I/we have read this Consent, Release and Agreement form and I/we understand the contents of the form.  I/we understand that the participation of the child named above in the named activities and programs is voluntary and that the child and I/we are free to choose not to participate in these activities and programs.  By signing this form I/we agree that I/we have decided to allow the named child to participate in these activities and programs and understand that the Town of Northbridge and its Playground & Recreation Commission will not be liable to anyone for bodily injuries and property damage the named child or I/we may suffer from participation in the activities and programs.

 

 

                                                                                                                                               

Signature of Parent/Guardian                             Date                                        Relationship

(Both parents must sign)

 

 

                                                                                                                                               

Signature of Parent/Guardian                             Date                                        Relationship

 

 

 

THIS FORM MAY NOT BE ALTERED