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Volunteer Registration Form

  1. NeighborhoodSrvsLogo_Blue

  2. VOLUNTEER REGISTRATION FORM

  3. Children under the age of 8 are unable to participate for safety. Children and young adults ages 8-17 must have adult supervision.

  4. Will you be responsible for driving yourself or others to the event*

  5. Emergency Contact Information

  6. The Information supplied herein is true and correct to the best of my knowledge.

  7. Electronic Signature Agreement ( OR PRINT AND SIGN)*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

  8. Parent / Guardian (if under 18)

  9. Parent / Guardian (if under 18)

  10. BY SUBMITTING THIS FORM, YOU AGREE TO THE FOLLOWING:

    AUTHORIZATION AND RELEASE - The undersigned does hereby waive, release, hold harmless and indemnify the City of Balch Springs, Texas, its successors and assigns, and its agents, representatives and employees from and against any and all damage, liability, claims, causes of action and demands that may in any way arise from the undersigned’s participation in City sponsored or City promoted programs, events and community service participation, such waiver, release, holding harmless and indemnification being without limitation, whether such damage, liability, claim, cause of action or demand is due to or arises from the negligence of any person, whether or not compensated from the proceeds of insurance coverage. The undersigned acknowledges that participation is voluntary. This release shall inure to the benefit of and shall be binding on the heirs, successors and assigns of the parties hereto. If the program participant is under the age of eighteen (18) years, the parent or legal guardian of such child also executes this document and agrees and consents to the terms and provisions hereof.

  11. If Mailing or Faxing

    Return to: City of Balch Springs, Attn: Neighborhood Services, 13503 Alexander Road Balch Springs, TX 75181 (F) 972-557-5115

  12. Leave This Blank:

  13. This field is not part of the form submission.