V O L U N T E E R A P P L I C A T I O N Date ____________________ Hours _________________________ Date ____________________ Hours _________________________ Date ____________________ Hours _________________________ Date ____________________ Hours _________________________ Date ____________________ Hours _________________________ 9 2017 Florida Senior Games Clearwater/Pinellas County, Florida • December 2-10, 2017 Upon Completion, Please Return Form To: Florida Sports Foundation; Attn: Senior Games Volunteers; 101 N. Monroe St., Suite 1000, Tallahassee, FL 32301 2017 Florida Senior Games Sports Archery • Bag Toss • Basketball 3 on 3 • Basketball Shooting • Billiards • Bowling • Cycling • Golf • Horseshoes • Lawn Bowls Pickleball • Powerlifting • Racewalk • Racquetball • Road Race • Shuffleboard • Swimming • Table Tennis • Tai Chi • Tennis Track and Field • Volleyball Personal Information (PLEASE PRINT) First Name _________________________________ Last Name ____________________________________________ MI _______ Male Female Address _____________________________________________________________________________________________________________________________ City _______________________________________________________________________________________ State _________ Zip ______________________ Day Phone ________________________________ Evening Phone ___________________________ Cell Phone _______________________________ Email ____________________________________________________________________________________________________________________________ *DOB (Month/Day/Year): ______________________________ *MUST BE 14 YEARS OF AGE OR OLDER TO VOLUNTEER Emergency Contact Name ________________________________________________________ Contact Phone ______________________________ T-shirt Size (circle one): S M L XL XXL XXXL Please note sports or areas of interest, note “any” if no preference ________________________________________________________________ _________________________________________________________________________________________________________________________________ Please note days and times of availability: Date ____________________ Hours _________________________ Date ____________________ Hours _________________________ Date ____________________ Hours _________________________ Date ____________________ Hours _________________________ VOLUNTEER - WAIVER AND RELEASE FROM LIABILITY: In consideration of being permitted to serve as a volunteer for the Florida Senior Games, I, on behalf of myself and my heirs, executors, administrators and assigns, do hereby refuse and forever discharge Enterprise Florida and Florida Sports Foundation the city, county and state in which I may serve as a volunteer, and all sponsors, producers, their agents, representatives, successors and assigns of any liabilities, claims, actions, damages, costs or expenses which I may have against them arising out of or in any way connected with my participation as a volunteer, including travel to or from my volunteer assignment or assignments or other volunteer activities and meetings, and including injuries which may be suffered by me before, during or after my participation as a volunteer. I understand that this waiver includes any claims based on negligence, action or inaction of any of the above parties. I have carefully read this volunteer release and fully understand its content. I am aware that this is a release of liability and sign it of my own free will. Dated, this ______ day of _______________, 2017. Signature ____________________________________________________________ PARENT/GUARDIAN - WAIVER AND RELEASE FROM LIABILITY (If applicant is under 18 years of age, a parent or guardian must execute in addition to the above, this following waiver.) The undersigned ,_______________________________, referred to as the parent, and natural guardian or legal Guardian of ______________________, does hereby represent that he/she is, in fact, acting in such capacity and agrees to save and hold harmless and indemnify each and all of the parties herein referred to above as releases from all liability, loss, cost, claim or damage whatsoever may be imposed upon said releases Because of any defect or lack of such capacity to act and release said releases on behalf of the undersigned. Parent/Guardian Signature _____________________________________________ Relationship to Minor ________________________________________
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