NAME

Last Name:

First Name:
Middle Name:

ADDRESS

Street Number and Name:
City:
State:
Zip Code:

CONTACT INFORMATION

Telephone:
Cell Phone:

E-mail:

AREA OF INTEREST

(Please select all that apply)

Special Events
EID
Leisure Programs
Clerical
Marketing / Outreach
Fundraising
Videographer

REASON FOR VOLUNTEERING

(Please select the reason(s) that apply)

I am part of the community.
My employer encourages volunteerism.
I need hours for High School credit and graduation.
I need to complete mandated hours for community service.

EXPERIENCE

Please describe your employment, previous volunteer experience, skills, hobbies, talents, etc.

EMERGENCY CONTACT INFORMATION

Name:
Last Name:
First Name:
Middle Name:
Street Number and Name:
City:
State:
Zip Code:

VOLUNTEER AGREEMENT

I, , certify that all statements on this application are true and complete to the best of my knowledge. Further, I understand that the position for which I am applying is voluntary and no compensation for the service performed will be given, with the exception of possible reimbursement of incidental expenses upon prior approval. The work I will be performing can be suspended or terminated at any time as determined necessary by the supervisor or any other supervisor within the UTWSD. I also understand that I am under no obligation to work, that I am not an employee, and no work performed as a volunteer can be considered employment with the UTWSD; however, I will give three (3) working days prior notice if I cannot perform a duty assigned.

WAIVER OF LIABILITY

I, , voluntarily agree to participate as a volunteer. I hereby waive, release, and hold harmless the United Taxi Workers of San Diego and its elected and appointed officials, agents, and employees from any liability or claims for damages for personal injury, including death, as well as from any and all claims of any type which may arise in connection with the above-named activity.

ACKNOWLEDGEMENT OF WORKERS’ COMPENSATION

I hereby acknowledge that as a volunteer for the UTWSD, I am not an employee of the UTWSD, but that I am covered under the UTWSD workers’ compensation plan since the UTWSD has adopted a resolution extending workers’ compensation coverage to certain volunteers in specified categories pursuant to Labor Code Section 3363.5. As a volunteer who is covered under the UTWSD workers’ compensation plan, I expressly agree and acknowledge that workers’ compensation is my exclusive remedy for any injury suffered while performing said volunteer duties, and that I cannot and will not seek to bring any other claim or actions of any type whatsoever against the UTWSD, its employees, officers, agencies, other volunteers, and officials.

Signature

X
Date:

Parent Signature (Required if applicant is under 18 years of age)

X
Date:

Emergency Information

Name:
Telephone Number:
Relationship: