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City of Richmond Volunteer Form

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Please complete the following form.
Personal Information
Education
Employment
Availability
Depending on the department a background check could be required?
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Emergency
References
Criminal Convictions
Terms and Conditions
Please carefully read the following statements.
I agree to volunteer my services to the CITY OF RICHMOND, California("City") or a partnering agency.

I acknowledge that there is no salary or other compensation of any kind to be provided by the City of Richmond for my
services as a volunteer.

I understand that the City of Richmond may photograph or videotape the events or activity in which I am (or my child is)
participating. I give my permission for the City to use photographs or videotape of me (or my child) for the purpose of
promoting the City of Richmond and its services/programs. I give my permission with the following understanding: No
compensation of any kind will be paid to me (or my child) at this time or in the future for the use of my (or my
child's) likeness.

The Program is under no obligation to accept all interested volunteers. Any or all of the following could be required before placement in certain volunteer positions: Fingerprinting or Background Investigation.

State law requires that all persons working with minors be fingerprinted and undergo a state and federal background check.

I hereby release the City of Richmond, its officers, agents and employees from any and all liability, claims, cause of action, or actions, arising out of or occasioned by bodily injuries or
property damages sustained by me as a result of my volunteer services to the City.

If volunteer is under 18 years of age, a parent’s/guardian’s phone number is required.

I understand that during the course and scope of my volunteer services to the City, I will be covered under the City's Worker's Compensation self-insurance. I also understand and agree that my sole remedy for any injury that I may sustain during the course and scope of my volunteer services to the City, which is covered by Worker's Compensation, shall be through the City's Worker's Compensation self-insurance coverage. I waive any other right or remedy that I may have available to me for the injuries described above.

I also acknowledge and agree that my services are provided for the convenience of the City and may be terminated for any reasonor for no reasonand at any time by the City without notice or hearing.

I, the undersigned, certify that the information stated on this application is true, complete and correct to the best of my knowledge and belief and is made in good faith. Any false statements made by me may be used as a basis of rejection for this application.




 
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Richmond, CA 94804
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