Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Application for Volunteer Service (No Background)

Steps

1. Volunteer Information This section is complete This section is incomplete
2. Release of Liability This section is complete This section is incomplete

Volunteer Information

Application for Volunteer Service (No Background)
Name:*
Primary Phone:*
Address:*
Secondary Phone:
City*
State:*
Zip Code:*
Email Address:
IN CASE OF EMERGENCY:
Contact Name: *
Contact Phone:*
Address:
Relationship:
CRIMINAL HISTORY INFORMATION
Have you ever been convicted for a violation other than a minor traffic offense?*
1. Yes
2. No
Please list the date and nature of the offense*
I hereby certify that the information on the above application is true and is complete to the best of my knowledge. My signature authorizes the CIty of Bridgeport to verify any information on this application and to require me to provide any additional information if needed or requested..
Signature:*
Date:*
Continue

Release of Liability

RELEASE OF LIABILITY
STATE OF TEXAS
§
§
COUNTY OF WISE
§
I acknowledge that I am at least eighteen (18) years of age and do hereby agree to participate in the Volunteer Program sponsored by City of Bridgeport. In consideration of being allowed to participate, I assume the risk of personal injury to myself and for property damage to my property.
I HEREBY ASSUME ALL RESPONSIBILITY AND RISK AND AGREE TO HOLD HARMLESS AND RELEASE THE CITY OF BRIDGEPORT, ITS OFFICERS, AGENTS AND EMPLOYEES, FROM ANY AND ALL CLAIMS OR SUITS FOR PROPERTY DAMAGE OR LOSS, OR PERSONAL INJURY, INCLUDING DEATH, SUSTAINED BY ME IN CONNECTION WITH MY SERVICES, WHETHER OR NOT SUCH DAMAGES OR INJURIES ARE CAUSED DIRECTLY OR INDIRECTLY BY THE NEGLIGENCE OF OFFICERS, AGENTS OR EMPLOYEES OF THE CITY OF BRIDGEPORT. FURTHERMORE, I HEREBY ASSUME ALL RESPONSIBILITY AND AGREE TO INDEMNIFY, HOLD HARMLESS AND DEFEND THE CITY OF BRIDGEPORT, ITS OFFICERS, AGENTS AND EMPLOYEES, FROM ANY AND ALL CLAIMS OR SUITS, FOR PROPERTY LOSS OR DAMAGE AND/OR PERSONAL INJURY, INCLUDING DEATH, SUSTAINED BY OTHERS BY REASON OF MY PERFORMING VOLUNTEER SERVICE.
I further understand and agree that as a volunteer, I am not an officer, agent, or employee of the City of Bridgeport, and that my service in such activity shall not be construed or interpreted as same, and that the doctrine of respondeat superior shall not apply between the City of Bridgeport and me.
I certify that I have read this release thoroughly and that I understand its terms and conditions and that I make this release and waiver voluntarily and have not relied upon any representations made by the City of Bridgeport, its officers, agents, employees or volunteers. I further certify that I understand that in making this waiver of liability I am making a decision of substantial significance and I am willing to assume such risks.
DO NOT SIGN UNTIL YOU HAVE READ AND UNDERSTOOD THE CONTENTS OF THIS DOCUMENT. UPON SIGNING, YOU SIGNIFY THAT YOU HAVE READ, UNDERSTAND AND AGREE TO ALL TERMS CONTAINED HEREIN.
By Signing Below, i have agreed to this Release of Liability on the date listed.
Signature:*
Date:*

Leave This Blank:

1. Receive an email copy of this form.
Email address

This field is not part of the form submission.
Submit | Go Back

Search Forms:

Application for Volunteer Service (No Background)

Steps

Volunteer Information

Release of Liability