2016 UNI Parental Consent & Release From Liability For Child Volunteer 

Please return this completed form to the service site supervisor or by email to swhitham@unidetroit.org

Voluntary Participation

I acknowledge that my child __________________________________] is at least fourteen (14) years of age and has voluntarily applied to volunteer with Urban Neighborhood Initiatives.

I understand as a volunteer that my child will not be paid for his/her services, that he/she will not be covered by any medical or other insurance coverage provided by Urban Neighborhood Initiatives, and that he/she will not be eligible for any Workers Compensation benefits.

Voluntary Participation

I acknowledge that my child __________________________________ is at least fourteen (14) years of age and has voluntarily applied to participate in _________________, a project including __________________________________________.

I understand as a volunteer that my child will not be paid for his/her services, that he/she will not be covered by any medical or other insurance coverage provided by Urban Neighborhood Initiatives, and that he/she will not be eligible for any Workers Compensation benefits.

Release

In consideration of the opportunity afforded my child to volunteer with Urban Neighborhood Initiatives, I hereby agree that my child, my assignees, heirs, guardians, and legal representatives, will not make a claim against Urban Neighborhood Initiatives, or any of its affiliated organizations, or either of their officers or directors collectively or individually, or the supplier of any materials or equipment that is used by Urban Neighborhood Initiatives, or any of the volunteer workers, for the injury or death of my child or damage to his/her property, however caused, arising from his/her participation as a volunteer with Urban Neighborhood Initiatives. Without limiting the generality of the foregoing, I hereby waive and release any rights, actions, or causes of action resulting from personal injury or death to my child, or damage to his/her property, sustained in connection with his/her participation in the volunteer program of Urban Neighborhood Initiatives

I further consent to the unrestricted use by Urban Neighborhood Initiatives, and/or person(s) authorized by Urban Neighborhood Initiatives of any photographs, recordings, interviews, videotapes, motion pictures, or similar visual recording of my child.

In case of emergency, please contact me as follows:

SIGNED this              day of                        , 20        

Parent/Guardian: _____________________________________________________

Witness: ____________________________________________________________

Please Print

Name: ___________________________________________________________

Address: _________________________________________________________

City: __________________________ State: ____________ ZIP: ____________

Telephone Number: ________________________