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Administrative Services 823 E. Avenue Q-9, Suite B Palmdale, CA 93550 661/267-5473 Fax 661/267-5410 Page 1 of 2 Volunteer Release of Liability — ADULT REV. 02/17/16 VOLUNTEER RELEASE OF LIABILITY — ADULT Volunteer’s Name: Age: Address: Emergency Contact Name: Phone: Email: I would like to receive notice of future service events and volunteer opportunities: ☐Yes ☐No Volunteer wishes to take part in (“Activity”) (Date). I understand that this agreement is required for my participation as a volunteer for the City of Palmdale (“City”), and that participation is conditioned on my compliance with this Agreement and the Policies and Procedures of the City of Palmdale. My signature on this document indicates the following: I hereby agree to indemnify, defend and save harmless the City, and their elected and appointed officials, officers, employees, agents and volunteers, from any and all loss, liability, damage or cost they may incur due to any claims arising from my presence in, upon or about City premises or facilities or equipment or participation in Activity whether by City’s negligence, my negligence, other volunteers’ negligence, or otherwise. I understand that my participation as a volunteer can result in bodily injuries, including but not limited to contusions, cuts, scrapes, head and/or dental injuries, and broken and/or sprained limbs, or death. I hereby assume full responsibility for and risk of bodily injury, death or property damage to myself due to the negligence of City or otherwise, while I am in, upon or about City premises or facilities or equipment or participating in the Activity. For myself, my heirs, executors, administrators, successors and assigns, I hereby fully release and discharge City, any claim or demands therefore on account of any injury to my person or property or resulting in death, whether caused by negligence or otherwise while I am in, upon or about City premises or facilities or equipment or participating in Activity. I acknowledge and agree that this release applies to all claims for injuries, damages or losses to my person and property, real or personal, whether those injuries, damages, or losses are known or unknown, foreseen or unforeseen, or patent or latent, that I may have against City in connection with Activity, and I hereby waive application of California Civil Code Section 1542. I certify that I have read the following provisions of California Civil Code Section 1542: “A general release does not extend to claims which the creditor does not know or suspect to exist in his favor at the time of executing the release, which if known by him must have materially affected his settlement with the debtor.” And indicate that fact by placing my initials here: initials I understand and acknowledge that the significance and consequence of this waiver of California Civil Code Section 1542 is that even if I should eventually suffer additional damages arising out of my participation as a volunteer for the City, I will be unable to make any claim for those damages. Furthermore, I acknowledge that I intend these consequences even as to claims for damages that may exist as of the date of this release but which I do not know exist, and which, if known, would materially affect my decision to execute this release, regardless of whether this lack of knowledge is the result of ignorance, oversight, error, negligence, or any other cause. In the event of a medical emergency, the City of Palmdale and its agents and employees, are authorized to immediately transport me to Palmdale Regional Medical Center and initiate any necessary medical care, for which I hold the City harmless. Signature Date ---PAGE BREAK--- Administrative Services 823 E. Avenue Q-9, Suite B Palmdale, CA 93550 661/267-5473 Fax 661/267-5410 Page 2 of 2 Volunteer Release of Liability — MINOR REV. 02/17/16 VOLUNTEER RELEASE OF LIABILITY — MINOR Volunteer’s Name: Age: Parent’s Name (if under 18): Address: Emergency Contact Name: Phone: Email: I would like to receive notice of future service events and volunteer opportunities: ☐Yes ☐No Volunteer wishes to take part in (“Activity”) (Date). I understand that this agreement is required for participation by my child as a volunteer for the City of Palmdale (“City”), and that participation is conditioned on the compliance of me and my child with this Agreement and the Policies and Procedures of the City of Palmdale. My signature on this document indicates the following: Parent, on his/her behalf and on behalf of child, hereby agrees to Indemnify, defend and save harmless the City, and their elected and appointed officials, officers, employees, agents and volunteers, from any and all loss, liability, damage or cost they may incur due to any claims arising from volunteer’s presence in, upon or about City premises or facilities or equipment or participation in Activity whether by City’s or Parent’s negligence or volunteer’s negligence or otherwise. Parent, on his/her behalf and on behalf of child, understands that child’s participation as a volunteer can result in bodily injuries to child, including but not limited to contusions, cuts, scrapes, head and/or dental injuries, and broken and/or sprained limbs, or death. Parent hereby assumes full responsibility for and risk of bodily injury, death or property damage to Parent or child due to the negligence of City or otherwise, while child is in, upon or about City premises or facilities or equipment or participation in the Activity. Parent, on his/her behalf and on behalf of child, their heirs, executors, administrators, successors and assigns, fully releases and discharges City, and their elected and appointed officials, officers, employees, agents and volunteers for any loss or damage and any claim or demands therefore on account of any injury to the person or property or resulting in death of Parent or child, whether caused by negligence or otherwise while child is in, upon or about City premises or facilities or equipment or participation in Activity. I acknowledge and agree that this release applies to all claims for injuries, damages or losses to my or my child’s person and property, real or personal, whether those injuries, damages, or losses are known or unknown, forseen or unforeseen, or patent or latent, that I or my child may have against City in connection with Activity, and I hereby waive application of California Civil Code Section 1542 on behalf of myself and my child. I certify that I have read the following provisions of California Civil Code Section 1542: “A general release does not extend to claims which the creditor does not know or suspect to exist in his favor at the time of executing the release, which if known by him must have materially affected his settlement with the debtor.” And indicate that fact by placing my initials here: initials I understand and acknowledge that the significance and consequence of this waiver of California Civil Code Section 1542 is that even if my child and/or I should eventually suffer additional damages arising out of my child’s participation as a volunteer for the City, my child and I will be unable to make any claim for those damages. Furthermore, I acknowledge that I intend these consequences even as to claims for damages that may exist as of the date of this release but which I do not know exist, and which, if known, would materially affect my decision to execute this release, regardless of whether her lack of knowledge is the result of ignorance, oversight, error, negligence, or any other cause. In the event of a medical emergency involving my child, the City of Palmdale and its agents and employees, are authorized to immediately transport my child to Palmdale Regional Medical Center and initiate any necessary medical care, for which I hold the City harmless.. Print Name of Parent/Guardian Signature of Parent / Guardian Date