Community Service/Volunteer Sign-Up

2. First Name*
3. Last Name*
5. Date of Birth*
   Date of Birth
6. Gender*

   1. Male
   2. Female
8. Age*
10. Address1*
12. City*
13. State*
14. Zip*
16. Email*
18. Phone Number*
20. Emergency Contact Name*
22. Emergency Contact Phone Number:*
24. Volunteer Events/Opportunities*

    Please select the event(s) or volunteer opportunities in which you are interested in volunteering.

    1. Kite Fest - 5/9 (11am-3pm)
    2. Chalk It Up - 6/12 (5-8pm)
    3. Tails & Treats: Pet Expo - 8/14 (5-8pm)
    4. Parade - 9/5 (10am)
    5. Family Fun Day - 9/5 (11am-4pm)
    6. Trunk or Treat - 10/24 (2-5pm)
    7. Veterans Celebration @ Konow's - 11/8 (11am-3pm)
    8. Homer for the Holidays - 12/5 (3-8pm)
    9. Other (indoor community service)
    10. Other (outdoor community service)
26. PARTICIPANT AGREEMENT, WAIVER AND RELEASE FORM

    THE FORM BELOW MUST BE COMPLETED BEFORE ANY PARTICIPATION WILL BE ALLOWED

28. AGREEMENT, WAIVER AND RELEASE

    In consideration of being permitted by the Village of Homer Glen to perform community service for the Village of Homer Glen, and/or participate in activities at Village of Homer Glen Parks and facilities, (hereinafter referred to collectively as “community activities”), I hereby waive, release and discharge any and all claims for damage for personal injury, death or property damage which I may have, or which may hereafter accrue to me, as a result of my performance of, and/or participation in said community activities. This release is intended to discharge the Village of Homer Glen, its officers, officials, employees, and agents, from any and all liability arising out of or connected in any way with my performance of and/or participation in community activities, even though liability may arise from the negligence or carelessness of the Village of Homer Glen, its officers, officials, employees and agents. It is understood that the community activities such as the ones I will be performing and/or participating in, involve an element of risk and danger of accidents, injury and harm, and knowing those risks, I hereby assume those risks. It is further agreed that this waiver, release and assumption of risk is to be binding on my heirs and assigns. I agree to defend, indemnify and to hold harmless, the Village of Homer Glen, its officials, officers, employees and agents, (hereinafter referred to collectively as “Indemnitees”), from any loss, liability, damage, cost or expense which they may incur as the result of my death or any injury or property damage that I may sustain while performing and/or participation in community activities. I understand that by performing and/or participating in said community activities, I consent to photo images taken by the Village of Homer Glen staff to be used in any or all Village of Homer Glen publications and websites.

30. CONSENT OF PARENT/GUARDIAN

    I am the parent or legal guardian of the Participant listed above. I hereby consent that the participant may perform and/or participate in the community activities and I hereby execute the Agreement, Waiver and Release on his/her behalf. I hereby affirmatively state and represent that the said Participant is physically able to perform and/or participate in the community activities, and agree to indemnify, defend and hold harmless the Indemnitees from any loss, liability, damages, costs, fees or expenses, including but not limited to attorneys’ fees, that they may incur as result of the death or any injury or property damage that said Participant may sustain while participating in the community activities.

    I HAVE CAREFULLY READ THIS AGREEMENT, WAIVER AND RELEASE AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A BINDING CONTRACT BETWEEN MYSELF AND THE VILLAGE OF HOMER GLEN AND I SIGN IT OF MY OWN FREE WILL. I HAVE BEEN AFFORDED AN OPPORTUNITY TO REVIEW WITH MY LEGAL COUNSEL.

32. For Participants Under the Age of 18

    If you are a minor, please have your parent or legal guardian sign below and include their relationship to you.

34. Relationship
36. Name*

    By typing my name, I intend to sign this agreement electronically and agree that this typed name is the legal equivalent of my handwritten signature for the purposes of validity, enforceability, and admissibility.

38. Date*
    Date
Leave This Blank:


40. 1. Receive an email copy of this form.
41. Email address

    This field is not part of the form submission.

42. Submit

* indicates a required field