2. ASSUMPTION OF RISK AND INDEMNIFICATION AGREEMENT
4. I understand that participation in a volunteer program with Roanoke County Parks, Recreation and Tourism carries the possibility of physical injury and may involve physical activity that may be strenuous, and that there are risks inherent in this activity. By my signature below, I do hereby agree to participate in and/or give consent for my minor child(ren) named below to participate in volunteer activities supporting Roanoke County.
6. I agree to only participate in volunteer activities on scheduled work days, and to perform only the duties approved and assigned by Roanoke County staff. This will involve the use of only hand tools unless proper certification has been obtained and permission has been granted from Roanoke County. I assume all risks and liability that may arise from my involvement and participation in this activity With regard to the activity to which this form applies, nothing shall be construed to grant an expressed or implied warranty of safety. I further understand that Roanoke County and its officers, agents, and volunteers are not liable for any injury that may result from the negligence of persons conducting this program.
8. Roanoke County recommends that participants secure adequate medical insurance to cover any injury that may arise from participation in this activity. I HAVE READ AND UNDERSTAND THIS AGREEMENT AND I AM AWARE THAT BY SIGNING THIS, I MAY BE WAIVING CERTAIN CLAIMS ON BEHALF OF MYSELF AND/OR MY MINOR CHILD(REN).
10. I Agree*

    1. Yes
12. CORONAVIRUS / COVID-19 ASSUMPTION OF RISK
14. The novel coronavirus, COVID-19, has been declared a worldwide pandemic. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. The County of Roanoke has put in place preventative measures to reduce the spread of COVID-19; however, the County cannot guarantee that you or your child(ren) will not become infected with COVID-19.
16. By signing this Agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I or my child(ren) may be exposed to or infected by COVID-19 by attending events, volunteer opportunities or activities sponsored by the County of Roanoke, including (the “Activities”), and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Roanoke County employees, volunteers, program participants and their families.
18. I voluntarily agree to assume all of the foregoing risk and accept sole responsibility for any injury to myself or my child(ren) (including, but not limited to, personal injury, disability, and death), illness, damage, loss, or expense of any kind, that I or my child(ren) may experience or incur in connection with my or my child(ren)’s participation in the Activities. On my behalf, and on behalf of my child(ren), I hereby release, covenant not to sue, discharge, and hold harmless the County of Roanoke, its employees, agents, and representatives, of and from any claims, actions, damages, costs or expenses of any kind arising out of or relating to the Activities. I understand and agree that this release includes any claims based on the actions, omissions, or negligence of the County of Roanoke, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in the Activities. I agree that this waiver of liability shall be governed by and construed in accordance with the laws of the Commonwealth of Virginia, and that if any of the provisions hereof are found to be unenforceable, the remainder shall be enforced as fully as possible and the unenforceable provision(s) shall be deemed modified to the limited extent required to permit enforcement of the waiver of liability as a whole. I HAVE READ AND UNDERSTAND THIS AGREEMENT AND I AM AWARE THAT BY SIGNING IT, I MAY BE WAIVING CERTAIN CLAIMS ON BEHALF OF MYSELF AND/ OR MY MINOR CHILD(REN).
20. I agree*

    1. Yes
22. Participant (or guardian) Name - Must be 18 or older:
24. Parent / Legal Guardian of the following minor participant(s):
26. Participant 1
27. Participant 2
29. Participant 3
30. Participant 4
32. Participant 5
33. Participant 6
35. Upon submission of this form, Roanoke County staff will receive an email copy of this document, and store it for at least three years on record under the name of the adult participant / legal guardian.
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37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit

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