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Rev. 3/2015 Volunteer Waiver & Release of Liability, Assumption of Risk and Indemnity Agreement - Adult Please print all information, sign where asked for signature. Volunteer Applicant Name: Address: Phone: E-mail: I, , (hereafter the “Undersigned”) being an adult over the age of eighteen (18), desire to participate in volunteer activities (the “Activity) of the City of Modesto’s Parks, Rec. & Neighbd. Department (the “City”). The Undersigned is fully aware of the risks and hazards connected with the Activity and hereby elects to voluntarily participate in said Activity, knowing that the Activity may be hazardous to me and my property. THE UNDERSIGNED VOLUNTARILY ASSUMES FULL RESPONSIBILITY FOR ANY RISK OF LOSS, PROPERTY DAMAGE OR PERSONAL INJURY, INCLUDING DEATH, which may be sustained as a result of being engaged in such Activity. 1. In exchange for participating in the Activity, the Undersigned on behalf of his or her self, heirs, estate, insurers, representatives and assigns hereby fully releases, waives, discharges and covenants not to sue the City of Modesto, its employees, elected and appointed officials, volunteers, attorneys, agents and any other person(s) acting on the City’s behalf (hereafter the ‘Releasees’) from any and all claims for bodily injury (including death), and other liability, damages, lawsuits, expenses (including but not limited to, medical expenses and attorneys’ fees) to the Undersigned or any other person, arising out of or relating to the Undersigned’s participation in the Activity and agrees to waive any rights to make the above claims through a lawsuit or otherwise against the Releasees above. 2. The Undersigned understands and acknowledges responsibility for any injury or damage the Undersigned causes to others during the Activity and hereby agrees to indemnify and hold harmless the Releasees from any and all claims for bodily injury (including death), and other liability, damages, lawsuits, expenses (including but not limited to, medical expenses and attorneys’ fees) resulting from participation in the Activity, whether caused by any act or omission of ordinary negligence of Releasees, or otherwise. 3. The Undersigned hereby grant to the City of Modesto and their legal representatives and assigns, the irrevocable and unrestricted right to use and publish photographs of me or my child under 18 years of age, for advertising and any other promotional purposes and in any manner and medium; to alter the same without restriction; and to copyright the same. I hereby release the City of Modesto and their legal representatives and assigns from all claims and liability relating to said photographs. 4. The Undersigned expressly agrees that the foregoing release and waiver and indemnity agreement are intended to be as broad and inclusive as permitted by California law. By signing below, I, acknowledge and represent that I HAVE READ THIS AGREEMENT CAREFULLY; I FULLY UNDERSTAND IT AND I VOLUNTARILY AGREE TO ITS TERMS. No oral representations, statements or inducement, apart from this written agreement have been made. If any portion of this agreement is declared invalid by a court, the remainder shall continue in full force and effect. Signed: Date: I hereby certify I have never been arrested for or convicted of any felony or misdemeanor involving sexual or physical abuse of any adult or child, or any felony narcotics offense. I authorize the City of Modesto to obtain my criminal records and understand that the fact that I am applying to volunteer will be reported to law enforcement agencies. All statements and information submitted on this application are true and correct. Applicant Signature: Date: