PHONE : 954-276-5597 | FAX : 954-602-2813 | EMAIL : MIRACLELEAGUE@MHS.NET
Miracle League Handouts

City of Pembroke Pines Parks and Recreation - Volunteer Form

Section 1
This section is to be completed by the volunteer

Name:
                First                  Middle                  Last
Address :
                Street #                  City                  State                  Zip Code
Telephone Number: Date of Birth:
School: Grade:
New Volunteer Past Volunteer      Email:
EVENTS YOU WISH TO VOLUNTEER FOR:
1.

Section 2
In Case of Emergency or Accident Please Notify:

Name:
                First                  Middle                  Last
Address :
                Street #                  City                  State                  Zip Code
Telephone #: Mobile #:
Relationship:

Section 3
This section is to be completed by the parent or legal guardian of the volunteer if under the age of 18

Parental Consent
I give my consent for my son/daughter to work as a
volunteer with the City of Pembroke Pines.
________________________________
Parent/Legal Guardian Signature                 Date

Section 4
All volunteers please read and sign.

I understand that I am volunteering to serve the City of Pembroke Pines without any
expectations of receiving compensation for my time and effort.

Release of Liability
Permit to participate in an event in Pembroke Pines, Florida, Volunteer, and my successors, heirs, assigns, executors, administrators, legal representatives, employees, agents, and affiliates (and in the case of a corporation, and its officers, directors, and shareholders) (collectively referred to as Volunteer), forever release and discharge The City of Pembroke Pines, and each of its officers, elected officials, directors, employees, agents, and affiliates (collectively referred to as The City of Pembroke Pines) from all claims, demands, obligations liabilities, causes of action and judgements whatsoever, in law or in equity, which against and of the foregoing, any or all of Volunteer ever had, now has or which they hereinafter can, shall or may have for, upon or by reason of any matter, cause or thing whatsoever arising out of Volunteer’s involvement in the Event. Volunteer agrees to and does hereby assume any and all risks of personal injuries to Volunteer, including death, and damages to Volunteer’s person or property, caused by or arising out of involvement in the Event. Volunteer hereby agrees to defend, indemnify and hold The City of Pembroke Pines harmless from and against any claim, demands, suit, loss, causes of action, damages, liabilities, obligations, attorney’s fees, costs, expenses, and judgements (including without limitation, death, and damages to property) caused by Volunteer’s acts or omissions and arising out of Volunteer’s involvement in the Event.

THE VOLUNTEER HAS READ AND UNDERSTANDS THE FOREGOING RELEASE AND INDEMNIFICATION AND HAS SIGNED IT VOLUNTARILY.

________________________________
Signature                                                   Date
________________________________
Parent/Legal Guardian Signature                 Date

If you have any questions, please call (954) 276-5597

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