Friends of Grand Rapids Parks · Volunteer Registration and Emergency Medical Authorization Form

Contact Information

Name

*

First Name

Last Name

Email

*

Verify Email

*

Would you like to receive periodic email updates?

Subscribe to our monthly e-newsletter to get information about volunteer projects, park updates, and more!

Yes

No

Address

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Home Phone

*

Cell Phone

Volunteer Demographics

Date of Birth

(mm/dd/yyyy)

Age

To which gender identity do you most identify?

Race/ethnicity

Household Size

Number of adults and children living within your household.

Emergency Contact Info

Emergency Contact Name

*

Relationship

*

Emergency Phone

*

Release, Waiver of Liability and Assumption of Risk

By signing this Registration and Emergency Medical Authorization Form (the “Registration Form”), the undersigned (the “Participant”) hereby releases and discharges Friends of Grand Rapids Parks (“FGRP”) and its officers, directors, employees, contractors, agents and any other related parties (“Representatives”) from any and all actions, claims, and/or demands for damages, wrongful death, or personal injury that the Participant now has or may have in the future arising out of an injury or loss sustained as a result of participation in FGRP activities or events. Participant, covenants, represents, and warrants that he/she does not have any health or medical conditions that would affect his/her ability to participate in FGRP activities or events. Furthermore, the Participant agrees that the Participant and his/her assignees, heirs, guardians, and/or legal representatives shall not make a claim against or bring suit against FGRP or its Representatives for any injury or damage resulting from the acts of FGRP and/or its Representatives, however, such acts are caused and whether such acts are active or passive.

Medical Release and Waiver

The Participant hereby authorizes FGRP and its Representatives to take whatever actions may be necessary to obtain emergency medical care in the event such care is warranted. These actions may include, but are not limited to, the following: (1) attempting to contact the Participant’s relative, parent, guardian or other emergency contact; and (2) calling 911 for emergency assistance and allowing emergency personnel to transport the Participant by ambulance or otherwise to a hospital as recommended by such emergency personnel. The Participant understands that the Participant shall be solely responsible for any and all medical costs incurred as a result of a medical emergency and subsequent treatment.

Photo Release

*

The Participant hereby grants FGRP the right to use the Participant’s image and/or likeness for publication and promotional purposes. The Participant agrees that FGRP may use the Participant’s image and likeness in any form and in any forum, including, without limitation, print, video, and/or other analog or digital form via the internet, television, or other promotional or display medium. The Participant further agrees that any uses described may be made without additional compensation or consideration. The Participant grants FGRP the right to crop or treat the Participant’s image and/or likeness in its sole discretion and agrees that FGRP may choose to use such image and likeness now or at a later date. The Participant hereby waives any right to inspect or approve any finished work that includes the Participant’s image or likeness.

Yes, I permit you to use my image and/or likeness for publication and promotional purposes.

No, I do not permit you to use my image and/or likeness for publication and promotional purposes.

Participant Signature:

*

Date

*

Parent or Legal Guardian Signature (if Participant is a minor):

Date