VOLUNTEER

I, the undersigned, hereby state that if accepted as a volunteer, I agree to abide by the rules and regulations of the Boys & Girls Club (hereafter known as the "Club"). I am not allowed to take the youth off the Club grounds. I have not been convicted, with the past ten years, of any felony or misdemeanor classified as an offense against a person or family, of public indecency, or a violation involving a state of federally controlled substance. I am not under current indictment. Further, I hereby fully release, discharge and hold harmless the Club, participating organizations and all of their employees, officers, directors, and coordinators from any and all liability, claims, causes of action, costs and expenses which may be or may at any time hereafter become attributable to my participation in volunteering. I understand that the Club staff reserves the right to terminate a volunteer from the program. I give permission for program staff to conduct a criminal background check as part of the screening for entrance into the program. This includes verification of personal and employment references as well as a criminal check with the authorities. Program staff has the final right of acceptance of applicants into the program and reserves the right to terminate a volunteer from the program at any time.

I have read this Release Statement and agree to the contents. I certify that all statements in this application are true and accurate.