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Department Division Supervisor Discription of Activities Community Service Roster Workers Compensation Notice, Concent to Medical Treatment, Consent to Use Images, Etc. I acknowledge that I / Minor child is providing voluntary service without pay. If I am unable to consent at the time due to injury, illness or absence, I hereby consent to administration of first aid and or other emergency medical treatment that occurs during me/my minor child in connection with the volunteer activities. I acknowledge that should administration of first aid or other emergency medical treatment be required that is not related to me/my minor child's volunteer avtivities that results in fees generated that I am responsible for all costs associated with medical treatment. I grant to Ogden City and their assigns the right to use, reproduce, display, and or distribute my/my child's voice and likeness recorded while engaging in the volunteer activities. Volunteer Name (Please Print Clearly) DOB Street Address /Zip Phone # Signature of Volunteer / Parent (if younger that 18) Date Read carefully before signing. By signing below, I understand and consent to the above.