35141000010236

Volunteer Program

Acknowledgement of Workers’ Compensation

I hereby acknowledge that as a volunteer for the City of Carpinteria (City) in the capacity of Library Volunteer, I am not an employee of the City, but that I am covered under the Agency's workers' compensation plan since the City has adopted a resolution extending workers' compensation coverage to certain volunteers in specified categories pursuant to Labor Code Section 3363.5.

As a volunteer who is covered under the Agency's workers' compensation plan, I expressly agree and acknowledge that workers' compensation is my exclusive remedy for any injury suffered while performing said volunteer duties, and that I cannot and will not seek to bring any other claim or actions of any type whatsoever against the Agency, its employees, officers, agencies, other volunteers and officials.

Volunteer Service Statement

In performing the service specified in my volunteer job description, I acknowledge:

• I have acquainted myself with what is required to perform my tasks, and represent that I have the skill and ability to perform them and know of no reason, medical or otherwise, which would prevent me from performing the tasks required;
• I will adhere to the safety training provided by the supervisor and assume full responsibility for my own safety;
• I will perform my volunteer service in compliance with the standards and specifications established for my position.

City of Carpinteria Volunteer Program
Consent and Liability, Indemnity and Participation Agreement

In consideration of my own and/or the below named individual(s) participation in the programs listed above, I voluntarily release the City of Carpinteria (hereby referred to as “City”), their officers, agents, employees and volunteers from any and all liability for injuries and death, or property damage resulting from or in any way connected with my and/or the individual(s) named below participation in the program. Additionally, as myself and/or as parent and/or guardian of the individual(s) named below, I do forever release and hold harmless and indemnify the City, their officers, agents, employees and volunteers from any and all claims or causes of action for any damages which myself and/or the below named individual(s) named has or may hereafter have, resulting from or in any way connected with my and/or the below named individual(s) participating in this program, either before or after the individual named below reaches their age of majority. I understand that this waiver and release is applicable even though the negligent activities of the City, their officers, agents, employees or volunteers may have caused or contributed to the injury or death or property damage. It is further understood that this Agreement is binding on my heirs and assigns, as well as those of the individual(s) named below.

I agree that pictures taken during program hours may be used for all future promotional purposes and hereby grant permission to the City to use my own or the below named individuals picture in City publications. I further agree on behalf of myself and the below named individual to release and discharge the City, its officers, agents, employees and volunteers from any and all claims or causes of action arising out of the photograph, name, image or likeness. In the absence of a signature below, payment of fees and/or participation in the program shall constitute acceptance of the conditions set forth in the release. I agree to return upon request equipment issued to the above participants in as good condition as when received except for normal wear and tear.