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Senior-center-volunteer-application - senior-center-volunteer-application

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File type: PDF

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BROWSE CITY OF ANTIOCH (CA) FORMS

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An
E
Nam
e
Maili
n
Cell
P
Email
A
re y
o
V
olu
n
I, __
_
1. I
2. I
e
p
3. I
a
s
h
4. I
T
I
c
V
List a
n
List a
n
E
qual Oppo
r
e
n
g
hone (
Address
o
u available
d
n
teer’s Ackn
_
__________
_
am a volunt
e
understand
a
e
xcept for co
v
p
erforming th
e
hereby relea
s
ctions, arisin
g
ervices to th
e
armless the
C
understand
a
T
he length of
t
represent an
d
onditions.
V
olunteer’s Si
g
n
y volunteer
w
n
y interests
o
r
tunity Empl
o
Last
Numbe
)
d
uring the da
y
owledgeme
n
_
________,
h
e
er, donating
a
nd acknowl
e
v
erage under
e
se services.
s
e the City, it
s
g
out of or oc
e
City, except
C
ity from any
a
nd agree tha
t
ime depend
s
d
warrant tha
g
nature ___
_
w
ork you ha
d
o
r expertise:
o
yer
r
y
? Yes
N
n
t
h
ereby state
a
my time, ser
v
e
dge I will re
c
the City’s W
o
s
officers, ag
e
casioned by
b
as otherwis
e
such liability
,
t this applica
t
s
upon on the
t I have read
_
__________
_
d
:
CITY O
Antioch
S
V
olunte
e
F
Street
N
o
a
nd agree as
v
ices and en
e
c
eive no sala
r
o
rkers’ Comp
e
nts and em
p
b
odily injurie
s
e
provided un
d
,
claim, caus
e
t
ion does not
quality of th
e
and fully un
d
_
_________
_
F ANTI
O
S
enior C
e
r
A
pplic
a
F
irst
Home
follows:
e
rgies to the
C
r
y, remunerat
i
ensation Pro
g
p
loyees from
a
s
or property
d
d
er Workers’
e
of action or
constitute a
c
e
job that I do
d
erstand the f
o
_
_________
_
O
CH
enter
a
tion
City
Phone (
Do you h
a
C
ity of Antio
c
ion or benefi
t
g
ram for any
a
ny and all li
a
d
amages su
s
Compensati
o
actions.
c
ontract for v
o
as a volunte
o
regoing an
d
_
_________
An
t
A
V
i
s
www.antioc
h
Middle
S
)
a
ve a Valid
C
c
h Senior Ce
n
t
s extended t
o
injury sustai
n
a
bility, claim
s
s
tained by m
e
o
n law, and
a
o
lunteer time
er.
d
seek to volu
Date ___
_
t
ioch Senior
213 F Stre
A
ntioch, CA
9
(925) 778-1
1
s
it our web
s
h
ca.gov/recreat
S
tate
C
.P.R. Card?
n
ter.
o
the employ
e
n
ed in the co
u
s
, cause of ac
e
as a result
o
a
gree to inde
m
for any defin
nteer under t
_
________
_
_
_
Center
et
9
4509
1
58
s
ite at:
ion/senior-cent
Zip
Yes No
e
es of the Cit
y
u
rse of
c
tion, or
o
f my volunte
e
m
nify and hol
d
n
ite duration.
hese
_
___
e
r
y
e
r
d
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Completed 10 July 2020

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