Previous Address (Please list if not at current address for 5 years or longer)

References (Please list 2 who are not family members)

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I understand and agree that:

1. The Huntley Park District can deny any volunteer for any reason or for no reason at all.

2. This form is only valid for the season indicated and a new form has to be completed for continued volunteer assignments thereafter.

3. By submitting this form I affirm that all the foregoing information I have provided is true and correct.

4. By submitting this form I agree (in return for being permitted to volunteer) that if any of the foregoing information is incorrect, I will forever indemnify and hold the Huntley Park District harmless for any acts or omissions on my behalf as they relate to any incorrect information I have provided.

5. By submitting this information I voluntarily waive my privacy rights to the extent necessary for the Huntley Park District to verify the foregoing information through any reasonable means, including, but not limited to local, state, national, and international criminal background check(s) and to inform those within the Huntley Park District who are responsible for accepting and/or supervising volunteers.