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Completion of the volunteer program application does not guarantee placement or engagement as a City of Milpitas volunteer program participant. Qualified volunteer applicants are considered without regard to race, color, religion, sex, national origin, age, marital status, non-job related medical condition or disability. For more information please call (408) 586-3210.
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Choose one: *
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Emergency Contact
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Availability & Assignment Request
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Please list times and days you are available to volunteer:
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Check all areas of interest: *
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Have you ever been convicted of a felony or misdemeanor (not including traffic citations)? *
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DO NOT SIGN THIS DOCUMENT BEFORE YOU READ IT AS IT CONTAINS A WAIVER AND RELEASE OF LIABILITY TO WHICH YOU WILL BE BOUND
I hereby give Milpitas Volunteer Services permission to request and obtain data pertinent to my volunteering at City of Milpitas programs for the individual named herein, and the California State Department of Justice if necessary. I also release from all liability or responsibility all persons and institutions supplying information. I certify that all statements made in this application are true and correct to the best of my knowledge, and I agree and understand that if I am accepted into the Milpitas Volunteer Partners program, any false statements may result in my dismissal.
I the undersigned do hereby agree to allow the individual named herein to participate in the Milpitas Volunteer Partners program and I further agree to indemnify and hold the City of Milpitas, its employees and contractors, harmless from and against any and all liability for any injury which may be suffered by the aforementioned individual arising out of or in any way connected with his/her participation in this program. I also agree to grant full permission to the City of Milpitas to use my name and any photographs, videographs, motion pictures or recordings for any publicity and promotion purposes without obligation or liability to me. I ACKNOWLEDGE THAT I HAVE CAREFULLY READ THIS WAIVER AND RELEASE AND I FULLY UNDERSTAND THAT, BY SIGNING BELOW, I AM WAIVING ANY RIGHT THAT I MAY HAVE TO BRING A LEGAL ACTION OR TO ASSERT A CLAIM AGAINST THE CITY OF MILPITAS FOR NEGLIGENCE.
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