Deborah Chase, 2002

In consideration of the Kenmore Heritage Society allowing me (my child/children) to participate in the Kenmore Heritage Society volunteer program, and being aware of the possible injuries that could occur as a result of that participation, I on behalf of myself (my minor child/children) release the Kenmore Heritage Society officials, employees, agents, instructors from any and all injuries and damages whatsoever arising from participation in the event. I, my heirs and representatives, agree to indemnify, save and hold harmless the Kenmore Heritage Society, its officials, employees and agents from any and all claims made by me (my child/ children) or my insurer for injuries or damages related to this event. I certify that all information provided on this application and during the interview process is true and complete. I understand that falsification or significant omissions of any information may be considered justification for non-acceptance or dismissal if discovered at a later date and that appointment to a volunteer position may be contingent upon the completion and review of a criminal background check. Please note that by signing below, you are affirming that all answers given in this document are true and correct to the best of your knowledge.

As a volunteer of our organization I agree to abide by the policies and procedures. I understand that I will be volunteering at my own risk and that the organization, its employees and affiliates, cannot assume any responsibility for any liability for any accident, injury or health problem which may arise from any volunteer work I perform for the organization. I agree that all the work I do is on a volunteer basis and I am not eligible to receive any monetary payment or reward.

I consent to the use of this material in any form by the Kenmore Heritage Society.