VILLAGE OF LINCOLNSHIRE, ILLINOIS
2019 Volunteer Waiver and Release
IMPORTANT INFORMATION
The VILLAGE OF LINCOLNSHIRE, ILLINOIS is committed to conducting its special event programs and
activities in a responsible manner and holds the safety of volunteers in high regard. The VILLAGE OF
LINCOLNSHIRE, ILLINOIS continually strives to reduce such risks and asks all volunteers to follow safety
rules and instructions designed to protect them. However, volunteers must recognize there is an
inherent risk of injury when choosing to volunteer for any municipal/Village activity or program. Please
recognize the VILLAGE OF LINCOLNSHIRE, ILLINOIS carries only limited medical accident coverage for
volunteers; therefore, it is strongly urged all volunteers review their own health insurance policy for
coverage. Additionally, each volunteer is solely responsible for determining if he/she is physically fit
and/or properly skilled for any volunteer activity. It is always advisable, especially if the volunteer is
pregnant, disabled in any way, or recently suffered an illness, injury or impairment, to consult a
physician before undertaking any physical activity.
WARNING OF RISK
Despite careful and proper preparation, instruction, medical advice, conditioning, and equipment, there
is still a risk of serious injury when participating in any Village special event activity/program.
Understandably, not all hazards and dangers can be foreseen. Volunteers must understand that
depending upon the activity, certain risks, dangers, and injuries due to acts of God, inclement weather,
slipping, falling, inadequate or defective equipment, failure in supervision or instruction, premises
defects, horseplay, carelessness, lack of skill or technique, and all other circumstances inherent to
Village special event activities/programs exist. In this regard, it must be recognized that it is impossible
for the VILLAGE OF LINCOLNSHIRE, ILLINOIS to guarantee absolute safety.
WAIVER AND RELEASE OF ALL CLAIMS AND ASSUMPTION OF RISK
Please read this form carefully and be aware that in signing up and volunteering for the 2019 calendar
year, you will be expressly assuming the risk and legal liability and waiving and releasing all claims for
injuries, damages, or loss which you may sustain as a result of participating in any and all activities
connected with and associated with your volunteer services (including transportation services, when
provided). As a volunteer, I recognize and acknowledge there are certain risks of physical injury to
volunteers in this program/activity, and I voluntarily agree to assume the full risk of any and all injuries,
damages or loss, regardless of severity, that I may sustain as a result of said participation. I further agree
to waive and relinquish all claims I may have (or accrue to me) as a result of volunteering in this Village
special event program/activity against the VILLAGE OF LINCOLNSHIRE, ILLINOIS, including its officers,
officials, agents, volunteers, and employees (herein collectively referred to as “Parties”).
I do hereby fully release and forever discharge the Parties from any and all claims for injuries, damages,
or loss that I may have or which may accrue to me and arising out of, connected with, or in any way
associated with my volunteer services. I have read and fully understand the above important
information, warning of risk, assumption of risk and waiver and release of all claims. If registering on-line
or via fax, your on-line or facsimile signature shall substitute for and have the same legal effect as an
original form signature. Photographs and videos are taken by staff to use for promotional purposes. By
registering for a program, attending an event or using a municipal/Village facility, you have granted us
permission to use your image for promotional purposes.
Volunteer’s Name (please print):
Date:
Address: Town/Zip:
Volunteer’s Signature: Phone:
Parent Name (If Volunteer is a Minor under 18):
Minors: Signature of Custodial Parent/ Guardian:
Phone:
Email (Optional):
Cell/Other:
PARTICIPATION WILL BE DENIED if the signature of the volunteer or custodial parent/legal guardian and
date are not on this form.
Submit