Volunteer Liability Release Form
I, ___________________, hereby release, indemnify, and hold harmless the City of
Hurst, the Volunteers-In-Action program, the Adopt-A-Street program, and their
respective officers, directors, employees, agents, contractors, subcontractors,
representatives, successors and assigns, and all persons conducting directly or indirectly,
the activities surrounding my involvement as a volunteer from any and all claims, rights,
demands, actions, causes of action, expenses and damages, which I or my heirs, personal
representative, successors, assigns or anyone claiming by, through or under me ever had,
now have, or may have against the parties identified above arising from any injury, act or
omission relating in the way to my participation as a volunteer.
I understand that I am to receive no payment for services from the City of Hurst. I am
not an employee. I will not be entitled to and will not receive Worker’s Compensations
benefits or other similar payments from the City of Hurst under the law of the State of
Texas in the event that I am injured.
I hereby consent that the City of Hurst, in conjunction with the Volunteers-In-Action and
Adopt-A-Street program, to copyright, publish, use, sell or assign any and all
photographic portraits or pictures, television spots, movie films, videotapes, and/or sound
records or any part thereof, that they may take or make of me during my work as a
volunteer in which I may be included in whole or in part, whether separate from or in
conjunction with, illustrative or written manner, story or news item, motion pictures,
television or radio spots, or for publicity, advertising or any other lawful purpose
whatsoever, in conjunction with my name or in anonymity. I hereby waive any right I
may have to inspect and/or approve the finished product or the advertising copy that may
be used in connection therewith or the use to which it may be applied.
I hereby waive all claims for compensation of such use or for damages.
I acknowledge that I have read, fully understand and am voluntarily signing this release
without any inducement from any member of the staff.
________________________________________________________________________
Signature of Volunteer Date
________________________________________________________________________
Signature of Parent/Guardian (if under 18 years old) Date
G:\USER\SHARED\COMSERV\VIA program\Volunteer Release Form Draft.doc