Mail Application to: San Dimas Volunteer Program, 245 East Bonita Avenue, San Dimas, CA 91773
CITY OF SAN DIMAS LIABILITY WAIVER
I fully understand that my participation, or that of the minor in my custody as registered, in the above-mentioned
activity, presents exposure to the risk of personal injury, death or property damage. I hereby acknowledge that
participation in this event/class is voluntary, without compensation and agree to assume any such risks. I hereby
release, discharge and agree not to sue the City of San Dimas, its officers, agents, employees or volunteers for any
injury, death or damage to or loss of personal property arising out of, or in connection with, participation in the
event/class from whatever cause, including the active or passive negligence of the City of San Dimas, its officers,
agents, employees or volunteers or any other participants in the event/class. In consideration for being permitted
to participate in the event/class, I hereby agree, for myself, my heirs, administrators, executors and assigns, that I
shall indemnify and hold harmless the City of San Dimas from any and all claims, demands, actions or suits arising
out of or in connection with my participation in the event/class. I also agree and acknowledge that participant
may be photographed while participating, and release use of the photographs for reproduction in City sponsored
publications.
I have carefully read this release, hold harmless and agreement not to sue, and fully understand its contents. I am
aware that it is a full release of all liability, and sign it on my own free will.
Date: Volunteer Signature:
Parent Signature:
Parent Signature Required for Youth Volunteers Only
CONTACT IN CASE OF EMERGENCY
Name: Relationship:
Address: Phone: ( )
City: CA Cell: ( )
OFFICE USE ONLY COMMENTS:
Volunteer Meeting:
Interview:
Assignment(s):
Coordinator Review: Date:
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