Riverdale City Flood Volunteer Roster 2023 
Please submit this form if you are interested in being contacted to volunteer in an emergency event. Information provided will be used to contact volunteers as needed. This form may also be used to register volunteers on site. Thank you! 
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Email *
Your Name *
Are you 18 or over?
**If you are under 18, please make sure a parent signs this form.**
 *
Phone number (best one to reach you) *
Additional phone number
Home address *
Emergency contact info 
(Please list name, phone number, and relationship)
 *
Volunteer descriptions *
Please select types of volunteering you would like to do (mark all that apply). If "other" is marked, please add a description in the "other skills and abilities" space. 
Required
Other skills and abilities (include certifications, training completed, etc.):
Are you able to perform the duties of selected volunteer positions without special accommodations for a disability or health concern? (Answering No does not automatically disqualify you for volunteer status) *

TERMS AND ACKNOWLEDGEMENT 

If I am accepted as a Riverdale City volunteer, I agree to perform the volunteer duties to the best of my ability and in a professional manner. I will appreciate constructive feedback. If problems arise such as scheduling, I will notify my supervisor as soon as possible before my assigned shift. 

I acknowledge that my service as a volunteer is at-will, meaning I have no right to continuing service as a volunteer. My service as a volunteer may be terminated at any time, for any reason or no reason. 

CONFIDENTIALITY: 

I agree to maintain strict confidentiality in the performance of my volunteer duties. 

RELEASE: 

While performing volunteer assignments and duties as a volunteer (unsalaried worker), authorized by the City, I shall be deemed an employee of  Riverdale city only to the extent provided for under the Utah Volunteer Government Workers Act, U.C.A. Title 67, Chapter  20, which includes the following: 

A. Medical Benefits under Worker’s Compensation for any injury sustained while engaged in performance of any service; 

B. Properly licensed operation of City vehicles or equipment; and 

C. Liability protection normally afforded paid employees. 

If I, as a Riverdale City volunteer, sustain injury, cause injury to another person, or damage city property or property of another person while performing volunteer duties, I shall immediately report such injury or damage to my volunteer supervisor and cooperate fully with Riverdale City in reporting and investigating such claims.  

With this knowledge, I hereby release Riverdale City and its agents and employees from any liability or obligation arising from, or in connection with, my volunteer activities with Riverdale City, other than as stated above. 

I have read and understand the above conditions. I certify that all information made in this application is true. I understand that I am required to abide by all rules and regulations, policies, and procedures of Riverdale City. 

If you agree to these Terms please sign your name (by typing) and date below. If under the age of 18, have your parent or guardian sign their name (by typing) and date below for you. 

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Can we contact you on short notice to volunteer? *
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