Volunteer Assumption of Risk Form

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Complete the following assumption of risk form

Email *

Volunteer Name *

Volunteer Email Address *

Volunteer Phone Number *

Activity or Sport Name *

Mountain Biking

Ultimate Frisbee

Cross Country

Volleyball

Basketball

Soccer

Track & Field

Required

I hereby acknowledge and agree that activities such as those listed above have inherent risks. such as minor physical/emotional injuries like cuts, bruises, sprains; to serious physical injuries like breaks, dislocations, serious wounds, cardiovascular concerns, traumatic brain injury and possibly even a risk of death. I have sufficient knowledge of the nature and extent of the risks associated with these activities and the use of facilities and equipment associated with these activities. If I had any questions or concerns regarding possible risks, I have addressed them with the activity/program or sponsor.
*

I acknowledge and agree

I further acknowledge that the risks communicated by the activity/program sponsor may not be inclusive of all the possible risks associated with my selected volunteer coaching activity at Compass and that the activity or program facilitator(s) may not have anticipated all of the risks associated with the above activities. I accept the fact that the program facilitator(s) cannot guarantee my total safety since some risks in such activities are beyond their control. I agree to follow all instructions
and guidelines given by the facilitators, and to act in a safe and responsible manner toward all participants. I fully comprehend and willingly assume the responsibilities and risks of participating in this program, as outlined in information communicated to me by the facilitator(s).
*

I acknowledge and agree

I understand that if I experience an injury/illness, including a concussion, then it is my responsibility to inform the activity/program sponsor immediately. I hereby give my consent to be seen by emergency medical personnel, a physician, or nurse and treated if
necessary in case of sudden illness or injury while participating in the above activity. It is understood that Jeffco Public Schools provides no medical insurance for such treatment and that the cost thereof will be at my expense.
*

I understand

I hereby waive, release, and discharge Compass Montessori School, Jeffco Public Schools, and their/its successors, heirs, assigns, directors, officers, employees, supervisors, agents, attorneys and representatives, from any and all actions, causes of action, claims, demands, losses, damages, costs, attorney fees, judgments, liens, indebtedness and liabilities whatsoever, regarding the aforementioned activity in which I have elected to voluntarily participate. Further, I acknowledge, understand, and agree that I will not be considered an employee of Jeffco Public Schools or Compass Montessori School. In the event of injury I acknowledge, understand, and agree that I will NOT be entitled to any workers' compensation benefits pursuant to the Workers’ Compensation Act of Colorado.
*

I acknowledge and agree to the above statement

Send me a copy of my responses.

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