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Carbon County Montana

info@co.carbon.mt.us

17 W. 11th St, PO Box 887, Red Lodge, MT, 59068, US

4064461595

Disaster Volunteer Registration

Personal Information

Emergency Contact Information

Skills - Check all that apply

Release of Liability Statement

I, the above listed Volunteer, desire to work as a volunteer for Carbon County and engage in the activities related to being a volunteer for disaster response and recovery.

I hereby voluntarily, execute this Volunteer Waiver under the following terms:

I, the Volunteer, release and hold harmless Carbon County and its successors and assigns from any and all liability, claims, and demands of whatever kind or nature, either in law or in equity, which arise or may hereafter arise from my volunteer work with Carbon County.

I understand that this Waiver discharges Carbon County from any liability or claim that I, the Volunteer, may have against Carbon County with respect to bodily injury, personal injury, illness, death, or property damage that may result from my participation on Carbon County’s work site. I also fully understand that Carbon County does not assume any responsibility for or obligation to provide financial assistance or other assistance, including but not limited to medical, health or disability insurance, in the event of injury, illness, death or property damage.

I, the Volunteer, understand that I expressly waive any such claim for compensation or liability on the part of Carbon County beyond what may be offered freely by the representative of Carbon County in the event of such injury or medical expense.

I hereby release Carbon County from any claim whatsoever which arises or may arise in the future on account of any first aid treatment or other medical services that are conducted in connection with an emergency during my time with Carbon County.

I understand that my time assisting Carbon County may include various activities that may be hazardous to me and I hereby expressly and specifically assume the risk of injury or harm in these activities and release Carbon County from all liability for injury, illness, death, or property damage resulting from the activities of my time with Carbon County.

I grant unto Carbon County all right, title, and interest in any and all photographic images and video or audio recordings that are made by Carbon County during my work with Carbon County, including, but not limited to, any royalties, proceeds, or other benefits that are derived from such photographs or recordings.

I expressly agree that this Waiver is intended to be as broad and inclusive as permitted by the laws of the State of Montana in the United States of America, and that this Waiver shall be governed by and interpreted in accordance with the laws of the State of Montana.  I agree that in the event that any clause or provision of this Waiver shall be held to be invalid by any court of competent jurisdiction, the invalidity of such clause or provision shall not otherwise affect the remaining provisions of this Release which shall continue to enforceable.

I, the undersigned, am at least 18 years of age or I am the parent or guardian of a participant who is less than 18 years of age.  I have read this Performance Authorization, Release, and Waiver of Liability and understand all its terms. I execute it voluntarily and with full knowledge of its significance.

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I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.