* Name:

* Address:

* Phone:  

* E-mail:

* Emergency Contact:  

* Relationship:   * Phone:

* VOLUNTEER EXPERIENCE Have you previously completed a volunteer application and orientation program? If so, which program?

* What  type  of   volunteer  work  have  you   previously  done?



* BACKGROUND INFORMATION Have you ever been convicted of any law violation? Include any plea of “guilty” or no contest.
(Please note: Failure to disclose convictions may disqualify you from volunteer placement).

Yes     No

I authorize the investigation of any and all statements contained in this application and obtain information about me from employers, and if I am 18 year or older, to perform background checks from law enforcement agencies, judgments and court records. I also authorize any person who has submitted a letter of reference at my request to provide relevant information and opinions that may be useful in making a placement decision. I release such persons from any legal liability in making such statements. I have read, understand, and by my signature consent to these statements.

RELEASE OF LIABILITY FORM

For Snow Removal

I certify that I am physically fit, have sufficiently prepared to participate in this activity, and have not been advised to not participate by a qualified medical professional. I certify that there are no health-related reasons or problems which preclude my participation in this activity.

I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows:

I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability and damages arising from the negligence or fault of the entities or persons released, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me including my traveling to and from this activity, THE FOLLOWING ENTITIES OR PERSONS: The Borough of Wildwood Crest and/or their elected officials, employees, volunteers, representatives, and agents (the “Releasees”).

The Accident Waiver and Release of Liability Form shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.

I CERTIFY THAT I HAVE READ THIS DOCUMENT AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL.

* Enter Your Full Name   * Date

Parent or Guardian's name if under 18   Date