City of Hawaiian Gardens Community Service Programs

Academic, Internship, Project Related or Volunteer Service Application

I am a: *

New Applicant

Returning Applicant

Purpose for volunteering: *

An education requirement for K-12

An education requirement for college or internship

A project requirement for an organization or service group

Community spirit (wanting to give something back to the community)

Name of school, college, or organization in response above (write NONE if Community Spirit was selected) *

If you are required to complete community service hours,

How many hours are required? *

Completion due date? *

Volunteer's Information:

First Name *

Last Name *

Age: *

Date of birth: *

Valid ID/DL No. *

Email Address *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone/Cell Number *

If under 18 years of age, name of parent or guardian: *

Background checks maybe conducted on all applicants prior to placement.

Availability: How many hours per week are desired? *

Please indicate all the days and times you are available for an assignment. Write the start time to the end time of your availability:

Monday Time: *

Tuesday Time: *

Wednesday Time: *

Thursday Time: *

Friday Time: *

Saturday Time: *

Special Skills, Talents and Languages: *

Is there a specific area or department you would like to volunteer in? NO YES If yes, indicate below: *

Do you have any prior volunteer experience *

YES

NO

If yes, please state where and describe duties: *

*Reasonable accommodations may be made upon request to enable individuals with legal disabilities to perform the essential functions that would not adversely affect safety considerations.

Emergency Contact Information:

In case of emergency contact:

Relationship: *

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

By signing this application,
I certify that all answers and statements are true and complete to the best of my knowledge. I understand that the City may verify the information and that untruthful or misleading answers are cause for the rejection of this application.

WAIVER AND RELEASE:
I, the “community service worker/volunteer,” working with the City of Hawaiian Gardens, do agree as follows:
1. To waive, release, discharge, and acquit the City of Hawaiian Gardens, its officers, staff, and representatives, its respective successors, predecessors, assigns, divisions, attorneys, and directors, whether past, present, or future, from any and all causes of actions, judgments, claims, liabilities, and demands of any kind, nature, and character for any injury, cause of action, action judgments, claims, liability, and demands of any kind, nature, and character which may result due to community service hours for the City of Hawaiian Gardens.
2. In making and executing this waiver and release, it is the expressed understanding that the community service worker does not rely and has not relied upon any representation or statement oral or written that is not contained herein, made by any party or any party’s agents, attorneys, or employees with respect to the matters contained herein, or with respect to the advisability of entering into executing this waiver and release.
3. The community service worker admits that there is no entitlement to attorney’s fees or costs. 4. This waiver and release shall be binding upon and inure to the benefit of the parties hereto and their respective successors, assigns, heirs, and personal representatives. I, the undersigned, warrant and represent that by executing this release and waiver that the City is expressly relying upon the warranties, representatives, promises, and statements made herein.

ACKNOWLEDGMENT OF WORKERS' COMPENSATION:
I hereby acknowledge that as a volunteer for the City of Hawaiian Gardens in the capacity listed above, I am not an employee of the City of Hawaiian Gardens, but that I am covered under the City’s workers’ compensation plan since Hawaiian Gardens, 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 City of Hawaiian Gardens 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 City of Hawaiian Gardens, its employees, officers, agencies, other volunteers, and officials.

ASSUMPTION OF THE RISK AND WAIVER OF LIABILITY RELATED TO COVID-19:
The City has created protocols and put in place preventative measures to reduce the spread of COVID-19; however, the City cannot guarantee that the undersigned and/or the community service worker will not become infected with COVID-19 when using the City Facilities or attending any program, and participation may increase the risk of contracting COVID:19. By signing below, the undersigned acknowledges the contagious nature of COVID-19 and voluntarily assumes the risk that the undersigned and/or the community service worker may be exposed to, or infected by COVID-19 by attending the program or using the City Facilities, and that such exposure or infection may result in personal injury, illness, permanent disability, and death. The undersigned understands that the risk of becoming exposed to or infected by COVID-19 at the program or by using the City Facilities may result from the actions, omissions, or negligence of others, including, but not limited to, City employees, volunteers, and program participants and their families. The undersigned voluntarily agrees to assume all of the foregoing risks and accept sole responsibility for any injury to the undersigned and/or the community service worker including, but not limited to, personal injury, disability, death, illness, damage, loss, claim, liability, or expense, of any kind in connection with attendance at the program or use of the City Facilities. The undersigned hereby releases, covenants not to sue, discharges, agrees to indemnify, and holds harmless the City, its employees, officials, volunteers, agents, and representatives, of and from all claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating to participation in the program or use of the City Facilities, including but not limited to as it relates to exposure, contraction, or infection of COVID-19 and any injury, illness, permanent disability, and death that may result therefrom. The Undersigned Has Carefully And Fully Reviewed The Agreement And Understands It. The Undersigned Understands The Risks Involved In The Participation Of The Program Or Use Of The City Facilities. The Undersigned Further Understands That They Are Giving Up Legal Rights By Signing This Agreement And Give Up The Right To Sue The City. The Undersigned Signs This Release Freely And Voluntarily And Without Inducement. The undersigned further agrees that no representations, statements, or inducements of any kind, apart from the foregoing written Agreement, have been made. *

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If under 18 years of age, Parent/ Guardian Signature: *

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Completion of the Remainder of this Form is Optional

Volunteers are recruited and selected on their interests, skills, knowledge, and abilities. A diverse corps of volunteers is both necessary and desirable. The program office uses the following demographic information to meet diversity goals.

Please check one: *

Check One Age Group: *

Special Events	Seniors
Youth Sports	Adult Sports
YAL	Fedde Sports Complex
CRL Game Room	Lee Ware Game Room
Clarkdale Park	Lee Ware Pool
Public Works	Office (clerical work)
Other Other