MFFF Application

Multicultural Family Fun Festival Application

First Name(*)

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Address 1(*)

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Address 2 (Apartment #)

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Disclaimer

As the volunteer or the guardian of the volunteer named above, I do hereby give my full consent and approval for my participation or the participation of my son/daughter/dependent, as a volunteer in the activity designated above. I understand and agree to assume full responsibility for any and all bodily injury, personal injury, and property damage that I, or the named individual for whom I serve as guardian, may sustain in the course of our volunteer work, whether it is the result of our actions, the actions of the County of Bergen, or any volunteer, agent, official, or employee of the County of Bergen. I further agree to Release and Hold Harmless the County of Bergen, from any volunteer, agent, official, or employee of the County of Bergen from any and all claims for injury or damage suffered by me, or the named individual for whom I serve as guardian. 
 
I understand that I am giving up my right to sue any employee, volunteer, or the County of Bergen, or any divisions of the County of Bergen for injuries I sustain in the course of my volunteer work.
I understand that the County of Bergen carries an accident policy, applicable to volunteers, with limits of $10,000.00 principal sum and $5,000.00 maximum accident medical expense, with coverage subject to the terms and conditions of the policy, a copy of which may be viewed upon request. I further understand that I am holding the County of Bergen, and any volunteers, employees or the County of Bergen harmless beyond the limits provided for in the Volunteer Accident policy, which will limit my recovery in any case where I am injured to a maximum recovery of $10,000.00 and $5,000.00 medical expense payments, subject to the terms and conditions of the policy. 
 
I am aware that I have the right to have this waiver form reviewed by an attorney if I choose.
 
I further authorize the following: 
	1. Use the above-named participant’s name in any and all media for publicity purposes. 
	2. Use the above-named participant’s photographs in any and all media for publicity purposes. 
	3. Make an audio/visual tape including the above-named participant for publicity/training purposes.

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Multicultural Family Fun Festival Application

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