Contact Information
First Name (*)
letters only
Last Name (*)
letters only
Birth Date
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Age
numbers only
Address (*)
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City (*)
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Zip (*)
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Primary Phone (*)
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Mobile
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Email (*)
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How may we contact you?
Email Text Phone
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Health or physical information or limitations you wish the City of Grapevine to consider in placing you in a volunteer activity:
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Education
Are you...
Employed Retired Student Other
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Highest level of education completed
Graduate School College High School Middle School
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Name of College
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High School
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Middle School
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Work Experience
Employer
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Title
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Job Duties
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Employer
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Title
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Job Duties
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Volunteer Experience
Organization
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Duties
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Rate the Experience
Loved it! It was ok. Didn't enjoy it.
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Organization
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Duties
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Rate the Experience
Loved it! It was ok. Didn't enjoy it.
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Interests
Areas you prefer to work with?
Beautification Litter Prevention Clerical Managerial Water Quality and Conservation Fundraising/Marketing Communications (newsletter, website, public speaking) Education/School Grant Programs No Preference
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Special interests, hobbies, skills, languages, etc.
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Have you volunteered with the City of Grapevine before?
Yes No
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If so, where/what did you do?
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Availability
Start Date
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End Date
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**If you need hours by certain date, please complete end date.**
# hours available per week
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# of days available per week
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If applicable, how many hours do you need?
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Required by Whom:
NJHS Ambassador Program Scouts Court Appointed Other
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Days available:
Weekdays:
Mornings Afternoons Evenings
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Weekends:
Mornings Afternoons Evenings
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Timeframe
After School Summer School Year
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Indemnity/Waiver Form
CONSENT: I waive all claims, fully release, indemnify, defend and hold harmless the City and all of its officials, officers, agents, consultants and employees in both their public and private capacities, from any and all liability, claims suits, demands or causes of action, including all expenses of litigation and /or settlement which may arise by injury to property or person occasioned by error, omission, intentional or negligent act, arising out of or in connection with my volunteer activities. This indemnity shall apply whether the claims, suits losses, damages, causes of action or liability arise in whole or in part from the intentional acts or negligence of my actions, whether said negligence is comparative negligence, concurrent negligence, gross negligence or any other form of negligence. Provided, however, that nothing herein shall waive the City
(*)
I have read this Indemnity Waiver Form and I am 18 years of age or older. I understand and agree with the contents of this document. If Volunteer is under the age of 18: I am the parent or legal guardian of the volunteer and I understand and agree with the contents of this document.
You must agree to the terms and conditions of the waiver.
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