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2. First Name*
3. Last Name*
5. Are you 18 years or older? If no, all minors must be accompanied by an adult.*

   1. Yes
   2. No
6. Are you with a group? *

   1. Yes
   2. No
7. Location Preference

   1. Walking from registration site
   2. Driving from registration site
   3. Surprise me! :)
9. If yes, what is the name of the group you are with? *
10. Email*
12. T-shirt size*

    1. Youth Large
    2. Small
    3. Medium

    1. Large
    2. X-Large
    3. 2X-Large

    1. 3X-Large
    2. 4X-Large

14.                               

    VOLUNTEER RELEASE AND WAIVER OF LIABILITY 

     Waiver and release of claims

    I understand that during the course of my volunteer activities with the City of Lima Spring Clean-Up Program, hazards may arise. I assume the risk of injury and fully and completely release, waive, and discharge the City of Lima and its officials, officers, employees, contractors, and agents, from any and all liability and damages for losses, injuries, death, damage, and any other claims connected in any way to my volunteer activities with the City. This release includes, but is not limited to any claims that may arise due to first aid, medical treatment, or other services rendered to me. Additionally, I agree to pay for any type of judgment and/or costs associated with any claims, including attorney’s fees that are made or threatened against the City of Lima or any of its officials, officers, employees, contractors, and agents arising out of any of my volunteer activities. 

     Volunteer status

    I understand that I am an unpaid volunteer for the City of Lima program. I waive all claims for compensation from the City for any services I perform in connection with my volunteer assignment with the City program. When performing volunteer services, I understand that I am not a City employee and I am not entitled to any employment-related benefits. The City does not have any responsibility to provide any health, medical, disability, or any other insurance coverage for me. It is my responsibility to ensure that I have insurance coverage if I want it. I also understand that I will not be entitled to workers’ compensation coverage.

     Image release

    I grant the City the unlimited right to use photographic images and video or audio recordings of me that are made during my volunteer assignment, including any royalties, proceeds, or other benefits from the use of these photographs or recordings.

     Background Checks

    I understand that a criminal history and background check may be obtained prior to my appointment as a volunteer. My signature below certifies that I agree to a criminal history check and agree to provide the City any information required to perform a criminal history or background check.

     Our policies

    I agree to follow and abide by City policies.

     Term of assignment

    After my volunteer assignment begins, I understand that the City may terminate my assignment at any time for any reason.

16. Electronic Signature*

    By checking "I Agree" you agree to the terms outlined in the Volunteer Release and Waiver of Liability and acknowledge your electronic signature is valid and binding in the same force and effect as a handwritten signature.

    1. I Agree
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18. 1. Receive an email copy of this form.
19. Email address

    This field is not part of the form submission.

20. Submit

* indicates a required field