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Parental Consent and Release Form

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  2. Read and fill out the form below.

    In order for your child to become a volunteer with the City of Roanoke's municipal volunteer program, we need your consent and your involvement in helping them have a productive experience. Please read and sign this parental consent and release form if you would like us to continue our process of considering your child as a volunteer. Please contact the Department of Human Resources at 540-853-2231 if you have any questions, would like further information, or would just like to discuss the volunteer program.

  4. 1. Voluntary Participation: I acknowledge that my child,

  7. is at least fourteen (14) years of age and has voluntarily applied to serve a volunteer in the City of Roanoke’s Municipal Volunteer Program. I understand that my child will not be paid for his/her services, and that should I be injured while performing duties on behalf of the City, the city provides insurance which offers limited medical benefits. This insurance has a $25,000 limit, is strictly excess and will only respond to expenses after all other insurance is exhausted. I also understand that my child will not be eligible for any Worker’s Compensation Benefits.

    2. Release: In consideration of the opportunity afforded my child to serve as a volunteer for the City of Roanoke through the Municipal Volunteer Program (MVP), I hereby agree that I, my child, my assignees, heirs, guardians, and legal representatives, will not make a claim against the City of Roanoke, or their officers or directors collectively or individually, or the equipment that is used by the City, or any of the volunteer workers, for the injury or death of my child or damage to my property, however caused, arising from his/her participation in the Municipal Volunteer Program (MVP). Without limiting the generality of the foregoing, I hereby waive and release any rights, actions, or causes of action resulting from personal injury or death to my child, or damage to his/her property, sustained in connection with my child’s participation in the Municipal Volunteer Program (MVP). I further consent to the unrestricted use by City of Roanoke’s Municipal Volunteer Program (MVP) and/or person(s) authorized by them of any photographs, recordings, interviews, videotapes, motion pictures, or similar visual recording of my child.

  9. I understand that my child named above wishes to be considered for volunteer work and I hereby give my permission for them to serve in that capacity, if accepted by the City. I understand that they will be provided with orientation and training necessary for the safe and responsible performance of their duties and that they will be expected to meet all the requirements of the volunteer position, including regular attendance and adherence to the policies and procedures for the City of Roanoke’s Municipal Volunteer Program(MVP). I understand that they will not receive monetary compensation for the services contributed.

  14. Electronic Signature Agreement
    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.
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