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2. Town of Fort Mill Volunteer Program

   Note: All  participants must sign this form. Signature of a parent/guardian is required if participant is less than eighteen (18) years of age. 

   Please read the form carefully.  By typing your name and submitting this form, you are electronically signing this waiver.  Paper versions are also available if you prefer. 

4. Group Name*

   The name of the group or organization with which you are participating in this volunteer activity

5. Date of Volunteer Activity*
   Date of Volunteer Activity
6. What activities are you participating in?*

   Check all that apply:

   1. Litter Clean Up
   2. Storm Drain Marking
   3. Stream Clean Up
   4. Adopt-a-Stream Testing
   5. Water Goat
   6. Adopt-a-Storm Drain
   7. Streambank Stabilization
   8. Other
8. Informed Consent, Liability & Hold Harmless, Publicity Permission

   I understand that on one or more occasions I/my child will be performing volunteer work as part of the Town sponsored volunteer program. 

   Said work will be performed with the support and direction of the above-mentioned  Group participating in the volunteer program. 

   I have read, and am familiar with, the General Program Conditions and Safety Guidelines provided to me by the Group, and agree to comply with said conditions and guidelines. 

   I understand that volunteer activities have a potential risk of injury. 

   I agree that I/my child will only perform those activities that I am/my child is capable of doing and able to do, and I acknowledge and assume the risks of all such activities. 

   I understand that participation in the volunteer activities is strictly voluntary and that I/my child may cease the volunteer activity at any time. 

   I agree that I will not hold the Group or the Town of Fort Mill or any of its agents, officers, employees, or representatives responsible for any damage or injury to me/my child or my/my child’s property as a result of volunteer participation in the volunteer program. I further agree to release, indemnify and hold harmless the Group and the Town of Fort Mill and all of its agents, officers, employees, representatives, successors and assigns from any and all damages, claims and/or liability arising out of my/my child’s activities as a volunteer participant in the volunteer program. 

   I give permission to the Town of Fort Mill Stormwater Department to include me/my child in any video productions or photographs that are made to document or publicize the volunteer activities. 

10. Informed Consent*

    By checking the box, you are accepting the terms and conditions in this waiver of consent, liability & hold harmless and publicity policy. 

    1. I agree to the above
12. Participant First Name*
13. Participant Last Name*
15. Participant Phone Number*
16. Participant Email*
18. Signature of Participant (over age 18) or Signature of Parent/Guardian*

    If the participant is over age 18, please sign.  If participant is under age 18, a parent/guardian must sign

19. Date*
    Date
21. Parent/Guardian First Name

    If signed by a parent/guardian

22. Parent/Guardian Last Name

    If signed by a parent/guardian

26. Emergency Contact*
28. Phone Number*
29. Relationship to Participant*
31. Email Address*
Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit Submit and Print

* indicates a required field