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City of Prescott

city.staff@prescott-az.gov

201 S. Cortez Street, Prescott, AZ, 86303, US

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Teen Task Force Participation Agreement Waiver of Liability

Mission Statement:

Teen Task Force is a local youth program driven to enhance the community through volunteering, peer support, and personal growth activities.

Full Name of Youth Participant

Full Address

Emergency Contact

In consideration of my participation as a volunteer for the City of Prescott Teen Task Force, on behalf of myself and all heirs, administrators, executors and assigns, I agree to the following:

Assumption of Risk and Waiver of Liability

 I hereby release and agree to hold harmless the City of Prescott, its employees and agents, from any and all liability for any damage or injury which may occur or result, regardless of the cause, from my participation in the Teen Task Force. This release of liability and agreement given by me to the City of Prescott, its employees and agents, shall apply to any claim, demand, suit or right of action that might accrue to myself, my heirs and my personal representatives, including claims of negligence. Further, I agree to assume all risks associated with my participation in the Teen Task Force, and I am fully aware that personal danger may be involved in this activity. I further understand that this Teen Task Force may be managed solely by other volunteers and that there may be no City staff present at the Teen Task Force events, and I agree to participate in the Teen Task Force with full knowledge of these conditions. I agree not to seek contribution or indemnification from the City, its employees or agents, if I am sued by any party in connection with my participation in the Teen Task Force which accrue outside the scope of my volunteer duties.

 Media Consent

 I consent to the unrestricted use of my image and/or my name, in connection with the Teen Task Force, by the City of Prescott or any person authorized by the City of Prescott, including, but not limited to, any photographs, audio or video recordings, interviews, videotapes, or motion pictures whether for television, radio, online or print media.

Tools and equipment

In consideration of the City of Prescott making its tools and/or equipment available for my use, I agree to hold harmless the City of Prescott, its employees, agents, officials, and officers from all liability, including claims or actions for physical injury, death, or property damage arising out of or in connection with the borrowed tool(s) and equipment, including those claims based on product liability or negligence. I agree to waive any and all claims that I may have against the City of Prescott, its employees, agents, officials and officers for any physical injury, death or property damage I experience arising out of the use of the borrowed tool(s) and equipment, including claims based in negligence. I acknowledge that the power tool(s) and/or power equipment must NOT be used by any person under the age of eighteen (18) years old. I acknowledge that the City of Prescott has provided the tools and/or equipment to me at no cost as a public service. It is my responsibility to check and inspect the equipment prior to use and to stop using the tools and/or equipment if I have any indication that it might be unsafe. I agree to notify the City of Prescott of any problems encountered when using the tools or equipment.

Participants

 I understand that I have voluntarily agreed to assist in the Teen Task Force, that the dates for the Teen Task Force events and meetings may be changed at the sole discretion of the City of Prescott, that I will not be paid for my services and that either the City of Prescott or I may terminate my participation at any time for any reason. I understand that by signing this Waiver I am giving up my right to sue the City of Prescott for any damages resulting from my participation in the Teen Task Force.

I, the undersigned, have carefully read all of statements above and fully understand their contents, and I am aware that this is a release of certain rights, and I sign this waiver and release of my own free will. Parental Consent (if participant is under 18 years old).

I, as the parent(s) or legal guardian(s) of the undersigned participant, give him/her permission to participate in the Teen Task Force. I (we) understand the foregoing provisions shall apply to my (our) child and fully and voluntarily agree to be bound thereto. By signing below, I (we) certify that I (we) am competent to enter into the agreement on behalf of my (our) child. In the event of a medical emergency, I (we) understand that every effort will be made to contact me (us) at the telephone number listed on this agreement. If I (we) cannot be reached, for any reason, I (we) hereby authorize the City of Prescott to seek treatment for my (our) child, and a copy of this permission form may be accepted by and treated by the physician or medical provider as the equivalent to the original permission form.

I, the undersigned, have carefully read this participation agreement and waiver of liability, fully understand its contents, and I am aware that this is a release of certain rights and sign it of my own free will.

Signature of Parent/Legal Guardian

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Youth Participant Acknowledgement of Waiver

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