General Practice, Solo & Small Firm DivisionMagazine

 

Adult Volunteer Waiver

I have agreed to perform services on behalf of ___________________ CLUB (the “Club”) strictly as a volunteer, and not as one of its employees. I verify that I am performing such services (1) without being under any contract for hire, express or implied; and (2) without receiving remuneration for the services other than a reimbursement for incidental expenses. I further verify that I am not performing services on behalf of the Club as a: (1) firefighter; (2) safety patrol officer; (3) civil defense worker; or (4) ambulance driver or attendant. This waiver is given in consideration of my being able to participate in the activities of which the services performed are a part.

Accordingly, I will not hold myself out as or claim to be acting in the capacity of an officer, employee, or servant of the Club, and will not make any claim, demand, or application for any right or privilege that might be claimed, demanded, or applied for by a person employed by the Club, including, without limitation, workers’ compensation, unemployment insurance, social security, salary, bonuses, retirement, membership, and credit, or any like employment benefit under applicable law, collective bargaining agreement, or custom. All rights under ________ law applicable to the employees of the Club are hereby expressly waived.

I agree to indemnify the Club and all of its related organizations, employees, agents, officers, and directors, and hold the same harmless from and against any and all damages, liabilities, costs, and expenses that may be incurred if I am determined to be an employee of the Club by any court or governmental agency (including but not limited to attorney fees, employment taxes, fringe benefits, and other benefits of employment) by reason of my participation as a volunteer in any event or activity sponsored or authorized by the Club.

I also agree to indemnify the Club and all of its related organizations, employees, agents, officers and directors, and hold the same harmless from and against any and all injury, loss, damage, liability, cost, penalty, or expense of any kind (including but not limited to attorney fees) that may be incurred by the Club, myself, or any third party, arising out of or resulting from any act or omission on my part (while participating as a volunteer in any event or activity sponsored or authorized by the Club) that constitutes gross negligence, or intentional, willful, or wanton misconduct.

I state that I am of lawful age and legally competent to sign this document; that I understand the terms herein; and that I have signed this document as my own free act.

My name (Please print): _____

My address: _____

Signature:_______________________ Dated: _____

Accepted on behalf of _________________________CLUB

By: _____

Dated: _____

Title: _____

This is a sample form. It may not be appropriate in your state, so check your state’s laws.

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