2. Hold Harmless Form For Volunteers

4. I, (Print Name) 

6. First Name*
7. Last Name*

9. (“Volunteer”) on behalf of myself, heirs, legatees, personal representatives, and all those claiming by or through me, consent to and so hereby discharge, release, defend, protect, indemnify, and forever hold harmless THE CITY OF KENNER (“Kenner”), its affiliates, sponsors, agents, servants, employees, assigns, and successors, from any and all present and future claims, demands, actions, losses, damages, or expenses for personal or bodily injury (including death) and property loss or damage, of whatever nature or cause, sustained while (briefly describe activity)

11. Activity*

13. I understand and agree that Kenner is not responsible for any injury or property damage arising out of the Volunteer’s activities, even if caused by Kenner’s ordinary negligence or otherwise.  (Initial)

14. Initial*

16. I understand that participating in volunteer activities for Kenner involves certain risks, including, but not limited to, serious injury and death. I am voluntarily participating in the activities listed above with knowledge of the danger involved, and I agree to accept all risks of participation. (Initial)

17. Initial*

19.  I understand that this agreement is intended to be as broad and inclusive as permitted by the laws of the State of Louisiana and agree that if any portion of this agreement is deemed invalid, the remainder will continue in full legal force and effect. 

20. Initial*

22. I understand that Kenner does not and will not carry insurance of any kind for my benefit, or for the benefit of any and all those claiming by or through me. I represent that, to my knowledge, I am in good health and suffer no impairment that would or should prevent my participation in the volunteer activities listed above. 

23. Initial*

25. I hereby consent I am of legal age and capacity and have read and understand the contents of this agreement.

27. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.

29. *Parent’s Signature (Required if under 18)

31. Electronic Signature*
32. Date*
    Date
34. Phone Number*
36. Emergency Contact Information
38. First Name*
39. Last Name*
41. Phone Number*
42. Relationship*
Leave This Blank:


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

    This field is not part of the form submission.

46. Submit Submit and Print

* indicates a required field