PRINCETON SPECIAL SPORTS & PROGRAMS - (PRINCETON, NJ)

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STUDENT VOLUNTEER REGISTRATION

THANK YOU FOR VOLUNTEERING! PLEASE MAKE SURE TO PROVIDE ALL REQUESTED INFORMATION.

* NAME:

* FULL ADDRESS (STREET AND TOWN):

* DATE OF BIRTH:

* YOUR PHONE:

* EMAIL ADDRESS:

* HOW DID YOU HEAR ABOUT PSS:

* WHAT SCHOOL DO YOU ATTEND, IF STILL IN SCHOOL:

LIST ANY MEDICAL CONDITIONS OR MEDICATIONS ABOUT WHICH MEDICAL PERSONNEL SHOULD BE ADVISED IN THE EVENT OF AN EMERGENCY:

* PARENT/GUARDIAN NAME IF UNDER 18:

* PARENT/GUARDIAN CELL PHONE IF UNDER 18:

I AM EITHER OVER 18 AND REGISTERING FOR MYSELF, OR I AM LEGALLY RESPONSIBLE FOR THE VOLUNTEER NAMED ABOVE. I CONFIRM THAT VOLUNTEER DOES NOT HAVE ANY PHYSICAL, COGNITIVE, PSYCHOLOGICAL, OR OTHER CONDITION THAT WOULD PREVENT OR IMPAIR HIS/HER/THEIR PARTICIPATION IN THIS ACTIVITY. I ACKNOWLEDGE THAT I MUST INFORM A PROGRAM REPRESENTATIVE IMMEDIATELY IF VOLUNTEER'S CONDITION CHANGES AT ANY TIME DURING, AND IN A WAY THAT IMPACTS, HIS/HER/THEIR PARTICIPATION IN THIS ACTIVITY. I AGREE THAT VOLUNTEER WILL COMPLY WITH ALL ACTIVITY RULES, REGULATIONS, SAFETY PROCEDURES, AND INSTRUCTIONS.

I ACKNOWLEDGE THAT VOLUNTEERING IN THIS ACTIVITY CARRIES A RISK OF SERIOUS INJURY OR ILLNESS. I VOLUNTARILY ASSUME ALL RISK AND RESPONSIBILITY, FINANCIAL AND OTHERWISE, FOR ANY INJURY OR ILLNESS NO MATTER WHAT THE CAUSE, INCLUDING BUT NOT LIMITED TO SARS-CoV-2, COVID-19, MIS-C, OR ANY OTHER PANDEMIC ILLNESS THAT MAY OCCUR AS A RESULT OF PARTICIPATION IN THIS ACTIVITY. I UNDERSTAND THAT THIS ACTIVITY IS NOT STAFFED WITH MEDICAL PERSONNEL AND AUTHORIZE THIS ACTIVITY'S ADULT STAFF TO CONSENT TO MEDICAL TREATMENT IN THE EVENT OF AN EMERGENCY. I CONFIRM THAT I HAVE PROVIDED ACCURATE AND COMPLETE INFORMATION, INCLUDING VOLUNTEER'S DIAGNOSIS(ES), MEDICATION(S), AND ALLERGY(IES) AS APPLICABLE AND AGREE THAT THIS INFORMATION MAY BE PROVIDED TO EMERGENCY MEDICAL PERSONNEL AS MAY BE NECESSARY.

I CONSENT TO THE USE OF THIS VOLUNTEER'S PHOTOGRAPH IN SOCIAL MEDIA AND OTHER PUBLICATIONS RELATING TO PRINCETON SPECIAL SPORTS & PROGRAMS, THE PRINCETON RECREATION DEPARTMENT, THE MONTGOMERY TOWNSHIP RECREATION DEPARTMENT, OR TOWN SQUARE PRINCETON. I UNDERSTAND THAT VOLUNTEER'S NAME WILL NOT BE PUBLISHED WITHOUT THE PERMISSION OF AN ADULT WITH THE AUTHORITY TO SO CONSENT.

I HAVE BEEN INFORMED THAT THE ABILITY TO RECOVER DAMAGES FROM PUBLIC ENTITIES SUCH AS THE PRINCETON RECREATION DEPARTMENT AND THE MONTGOMERY TOWNSHIP RECREATION DEPARTMENT, AS WELL AS THEIR OFFICERS, AGENTS, SERVANTS, AND EMPLOYEES, MAY BE LIMITED BY THE PROVISIONS OF THE NEW JERSEY TORT CLAIMS ACT, N.J.S.A. 59:1-1, et seq. REGARDLESS, I KNOWINGLY AND VOLUNTARILY RELEASE AND HOLD HARMLESS PRINCETON SPECIAL SPORTS INC. d/b/a PRINCETON SPECIAL SPORTS & PROGRAMS, THE PRINCETON RECREATION DEPARTMENT, THE MONTGOMERY TOWNSHIP RECREATION DEPARTMENT, AND TOWN SQUARE PRINCETON , AND THE OFFICERS, TRUSTEES, DIRECTORS, SPONSORS, BUDDIES, COACHES, VOLUNTEERS, UMPIRES, REFEREES, EMPLOYEES, AGENTS, ATTORNEYS, TRAINERS, GOVERNING BODIES OR ENTITIES, PROGRAM PARTNERS, AND REPRESENTATIVES OF EACH OF THEM (COLLECTIVELY PROGRAM SPONSORS) FROM ANY AND ALL CLAIMS OF WHATEVER NATURE, AND AGREE NOT TO BRING ANY LAWSUIT OR LEGAL ACTION AGAINST THE PROGRAM SPONSORS OR ANY OF THEM FOR ANY REASON WHATSOEVER.

I AGREE TO THE ABOVE *

* SIGNATURE OF VOLUNTEER OR PARENT/GUARDIAN IF VOLUNTEER IS UNDER 18:

* indicates required fields