Youth (under 18) Waiver of Liability/Sign-in Sheet
Sign in to Google to save your progress. Learn more
Email *
Youth Participants Name (first and last) *
I volunteer my services to this project sponsored by the Charles River Conservancy. I understand that I am going to have fun, work hard, and make a difference! I am ready to learn more about the local environment and how to protect and restore these special places. I understand that there are some risks of physical injury involved in my volunteer assignment, and I will study, understand and avoid any and all dangers. I will not accept any work assignment I feel I am not qualified or feel comfortable doing. I agree to release Charles River Conservancy of any and all claims that may arise as a result of any expenses, personal injury, loss or damages incurred while volunteering. I understand that pictures of me taken while participating at this Conservancy event may be used in promotional material such as social media (Facebook, e-newsletter, and/or CRC’s website), brochures, and videos.
I hereby acknowledge that during this volunteer maintenance event sponsored by the Charles River Conservancy, neither the Charles River Conservancy nor any affiliated organization or individual is responsible for ensuring in any way the safety of any activities at the volunteer maintenance event. Any decisions I make as to whether to participate in any activities at the Conservancy Volunteers event are my personal responsibility. I acknowledge that it is my responsibility to be aware of, and I accept, the inherent risks involved in the various activities that may be available during the volunteer maintenance event. I acknowledge that neither the Charles River Conservancy nor any affiliated organization or individual is undertaking any duty to assure my safety. I also agree to comply with all DCR rules and regulations.
I hereby release the Commonwealth of Massachusetts and the Department of Conservation and Recreation (DCR), their employees, and agents from all claims, loss, damage, expenses and/or injuries, whether to person or to property, which may result from my actions while participating in volunteer activities or projects approved or sponsored by the Department. I further agree to indemnify, defend, and hold harmless the Commonwealth of Massachusetts and the DCR, their employees, and agents from liability for any damage or injuries resulting from my actions while participating in volunteer activities or projects approved or sponsored by the Department, that are found to be outside the scope of approved activities or projects.
 I acknowledge that, by participating in such volunteer activities and projects, I have not received an appointment to state service and I will not receive a salary or payment from the Commonwealth. As such, I understand that I am not entitled to Workers Compensation and that I cannot make any claims against the Department for any injury, loss, or damage to person (including bodily injury or death) or property suffered while involved in volunteer work or projects for the DCR and, further, that I will provide my own health insurance.
I recognize that MGL c. 21, §17G provides that, pursuant to the provisions, requirements, and limitations of MGL c. 258 and the guidelines adopted by DCR, I shall not be liable for injury or loss of property or personal injury or death caused by my negligent or wrongful act or omission while acting within the scope of my volunteer activities. However, I acknowledge that I will not be indemnified under MGL c. 258, §9 for intentional torts or for the violation of a person’s civil rights. I also acknowledge that in any litigation, the final determination of whether a person is considered an uncompensated employee is made the Attorney General’s Office.
I hereby waive and release any and all claims that I, my heirs, successors or assigns may have against the Charles River Conservancy or any affiliated organization or individual for any injuries or damages in any way related to my participation in the volunteer maintenance event. Further, I agree to indemnify and hold harmless Charles River Conservancy and any affiliated organization or individual against any claims for injuries or damages arising out of or in any way related to my activities at the volunteer maintenance event. I give permission for the Charles River Conservancy to use my image for the purposes of program promotion and publicity. All negatives and prints shall constitute property of the Charles River Conservancy.
What is the date of the volunteer event? *
MM
/
DD
/
YYYY
What is the name of the group or school the youth participant will be volunteering with? If they are not volunteering with a group or school, please put N/A *
Digital Signature of Parent/Legal Guardian *
Please type your full name: for those under 18, a guardian must sign
Relationship to Participant *
Emergency Contact Phone Number *
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of Charles River Conservancy.

Does this form look suspicious? Report

Google Forms