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City of Pasco Recreation Services Division Volunteer Registration Official Use Form filled out completely WSP Form Attached References Checked Staff Initial Date: Volunteer position you are seeking: Name: Day time phone: Age (if under Email: Y / N (Cell: Y/N) Evening phone: Y / N (Cell: Y/N) Address: Emergency Contact Phone Contact person: Related Training & Experience: Days you are available: Sun___ Mon___ Tue___ Wed___ Thur___ Fri___ Sat___ Time you are available: Days to Evenings to List four personal references (Required): Name: Phone: Name: Phone: Name: Phone: Name: Phone: VOLUNTEER SCOPE OF AGREEMENT REGARDING INDIVIDUAL VOLUNTEER SERVICE , hereby volunteer my services to perform only the services as outlined above for the (mark one) ____Parks Division OR ___Recreation Services Division with the City of Pasco. I understand I will not be compensated for my work but I volunteer to do so in a responsible manner. If I decide to discontinue my volunteer service I will notify the Division for which I am volunteering (As marked above). Further, I hereby identify that I am capable of performing the duties as outlined in the attached scope of volunteer work (mark one) ____without accommodation or ___with the following accommodations: I ---PAGE BREAK--- In consideration of the City of Pasco giving me permission to perform these volunteer services, I agree to the following terms: (Please initial all that apply) 1. I understand that I am not to appear for volunteer service under the influence of any drugs or alcohol. 2. I will abide by all City/Department/Division policies regarding personal conduct while performing volunteer services. 3. I agree not to go beyond the scope of volunteer work agreed to without authorization. 4. Should an injury occur during the scope of my service, I understand that: The City of Pasco has included my hours of volunteer service in the State Labor and Industries coverage for volunteer workers. I understand that I am to report any on-the-job injury or illness, no matter how minor, to the Division Manager for which I am Volunteering and Human Resources. 5. Depending on the scope of volunteer work, the following policies may apply: (Please initial the policies reviewed) Driving Accident Prevention Program Professional Behavior/Discipline Youth Sports league rules & guidelines Substance Free Work Place Liability Reporting Prevention of Harassment & Discriminatory Behavior Internet & Other Workplace Communication Systems Reporting improper government action 6. I acknowledge that I have been oriented on the above initialed policies and understand them and/or have had the opportunity to ask any questions. 7. I consent to the City of Pasco performing a background check into my history in accordance with RCW 43.43.830-839 and waive any right of privacy I may have in such information for the limited purpose of determining my suitability as a volunteer. (To be used for volunteers who will have unsupervised access to children under sixteen years of age, developmentally disabled persons, or vulnerable adults). 8. I understand that I or the City may terminate this agreement at any time without cause, and that I am volunteering my services at will and may be asked to discontinue such without prior notice or reason. 9. I am fully aware that the work associated with being a Volunteer involves certain risks of physical injury or death. Being fully informed as to these risks and in consideration of my being allowed to participate in the City of Pasco Volunteer Program, I hereby assume all risk of injury, damage and harm to myself arising from such activities or use of City of Pasco Park and Recreation facilities. I also hereby individually and on behalf of my heirs, executors, and assignees, release and hold harmless the City of Pasco, its officials, employees and agents and waive any right of recovery that I might have to bring a claim or a lawsuit against them for any personal injury, death or other consequences occurring to me arising out of my volunteer activities. ---PAGE BREAK--- 10. I give my permission for photos/videos taken of myself during volunteer activities to be used for publicity purposes, without recompense. This agreement will be in effect for the duration of my volunteer services beginning with the date that this agreement is completely executed. Name: City Representative Volunteer's Signature Date Date Parent's Signature, if minor Date SIGN SIGN