FRESNO FIRE DEPARTMENT VOLUNTEER RELEASE

Name:_____________________________________________________________________________________________
                                                 (Last)                                                                        (First)                                                                   (Middle)

Previous Names (if Applicable):_________________________________________________________________________

Address:___________________________________________________________________________________________
	(Street)                                                      (City)	                                                (State)                                  (Zip Code)

Phone-Home:________________________ Work:_________________________ Date of Birth:______________________

California Drivers License Number:___________________________________________ Expires: ____________________


Background Check:  I authorized the Fresno Fire Department to conduct a background investigation; including a criminal records check and other information that may be of a confidential or privileged nature.  I authorized the Fire Department to use a copy or facsimile of this form to be considered the same as the original for the purposes of the background investigation.  
Check any that apply.  I have been:   (____) Arrested     (____) Convicted of a felony     (____) Convicted of a misdemeanor

Release of Liability: I, the individual named above, hereby request permission to participate in the Fresno Fire Department’s Volunteer program. I understand that training and/or assignments may involve physical activities, which include a potential risk of personal injury and/or personal property damage; and I make this request with full knowledge of these risks.  
I certify that I am able to perform the assignment I am applying for, and will disclose any medical conditions which may affect my safety or ability to perform my duties.  I agree to hold the City of Fresno, Fresno Citizen Corps Council and its directors, and their agents and personnel, harmless from any and all claims, actions, suits and/or injury that I may suffer which may arise as a result of my participation in the above mentioned 
program.


At-Will Status:  I agree to follow the rules established by my supervisor(s), and to exercise reasonable care while participating in the volunteer program.  I understand that if I fail to follow the rules/regulations or if I fail to exercise reasonable care, I can be administratively removed from the program. I am an at-will volunteer, without vested property rights in my position as a citizen volunteer and I may be released at any time without cause and without right of appeal. 

Photographs:  I authorize the use of any photograph taken in connection with my participation in the program without prior approval or compensation.  

By executing this form, I certify that I have read this release in its entirety, understand all of its terms and have had any questions regarding the release or its effect satisfactorily answered.  I sign this release freely and voluntarily. 

Signature:________________________________________________________________ Date:_______________________

Parental approval is mandatory for those under 18 and must be indicated by a signature below.  Parents are responsible for the transport and safety of their minor children before and after the hours of their volunteer assignment. 

Signature of parent/guardian:_________________________________________________ Date:_______________________