Volunteer Release Form DCR and WLT Volunteer Release Form 2024 Earth Day Cleanup Volunteer Release Form "*" indicates required fields I, (Insert your name)* a member of or participant in the activities sponsored by the Waltham Land Trust (WLT), 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 WLT and 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 WLT and 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. This Release Form is valid for the duration of my volunteer activities, including, but not limited to, from (Start Date of Service) April 20, 2024 to (End Date of Service) April 21, 2025 for the annual Charles River Cleanup. Volunteers must read and complete this release form to be eligible for volunteer activity. Typing your Name Below Indicates Electronic Signature.I give Waltham Land Trust and its partners permission to use, publish, republish and share photographic, video or digital images and reproductions of my likeness.* Yes Name of Participant* Date* MM slash DD slash YYYY Home Street Address* Home City, State, Zip* Cell Phone (for emergency use only)*Note: If you do not have a cell phone, enter "None". Emergency Contact and Phone Number*Enter the name and phone number of an emergency contact. Email (for emergency use only)*Note: If you do not have an email, enter "None". Emergency Contact and Email Address*Enter the name and email address of an emergency contact. For Persons Under 18, a Parent or Legal Guardian Must Check Box this box and Print their Own Name below: Yes Name of Parent or Legal Guardian Δ