DATE / EVENT TITLE
10am - 11:30am at the Ipswich Street Bridge (across from 50 Charlesgate East)
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Massachusetts Dept. of Conservation & Recreation (DCR) Release
I, as a member of or participant in the activities sponsored by The Muddy Water Initiative,  understand the work that I have volunteered to do and I hereby state that I am qualified and physically capable of  accomplishing the work and activities for which I have volunteered, and that I will perform them as directed by a  properly authorized supervisor. I also agree to comply with all DCR rules and regulations.  

I hereby release the Commonwealth of Massachusetts and the Department of Conservation and Recreation  (DCR), their employees, and agents from all claims, loss, damage, expenses and/or injuries, whether to person or to property, which may result from my actions while participating in volunteer activities or projects approved or  sponsored by the Department. I further agree to indemnify, defend, and hold harmless the Commonwealth of  Massachusetts and the DCR, their employees, and agents from liability for any damage or injuries resulting from my actions while participating in volunteer activities or projects approved or sponsored by the Department, that are  found to be outside the scope of approved activities or projects.  

I acknowledge that, by participating in such volunteer activities and projects, I have not received an  appointment to state service, and I will not receive a salary or payment from the Commonwealth. As such, I  understand that I am not entitled to Workers Compensation and that I cannot make any claims against the  Department for any injury, loss, or damage to person (including bodily injury or death) or property suffered while  involved in volunteer work or projects for the DCR and, further, that I will provide my own health insurance.  

I recognize that MGL c. 21, §17G provides that, pursuant to the provisions, requirements, and limitations of  MGL c. 258 and the guidelines adopted by DCR, I shall not be liable for injury or loss of property or personal injury or death caused by my negligent or wrongful act or omission while acting within the scope of my volunteer activities.  However, I acknowledge that I will not be indemnified under MGL c. 258, §9 for intentional torts or for the violation  of a person’s civil rights. I also acknowledge that in any litigation, the final determination of whether a person is  considered an uncompensated employee is made the Attorney General’s Office.  
Photo-Video Release
The undersigned, on behalf of the participant (if different), in connection with his/her participation in the Department of Conservation and Recreation (DCR), gives my permission for the Commonwealth of Massachusetts including its DCR to use photographs and/or video of me for publicity and media/social media purposes, including but not limited to internet publication and inclusion in any DCR publication.

I understand that this is an important waiver of my rights.
Name of Participant: *
Email Address: *
Date of Volunteer Service: *
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I consent to all information in the DCR Release. *
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I consent to all information in the Photo-Video Release. *
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If participant is under 18, please provide parent or guardian name & contact information.
I would like to receive email updates regarding future Muddy Water Initiative events.
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