EOEEA-DCR

Name(Required)

First Last

Date(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

I am a member of or participant in the activities sponsored by (Insert Name of the Sponsoring Organization, if Applicable),

Consent(Required)

I acknowledge and agree to the following statement

I understand the work that I have volunteered to do and I hereby state that I am qualified and physically capable of accomplishing the work and activities for which I have volunteered, and that I will perform them as directed by a properly authorized supervisor. I also agree to comply with all DCR rules and regulations.

I hereby release the Commonwealth of Massachusetts and the Department of Conservation and Recreation (DCR), their employees, and agents from all claims, loss, damage, expenses and/or injuries, whether to person or to property, which may result from my actions while participating in volunteer activities or projects approved or sponsored by the Department. I further agree to indemnify, defend, and hold harmless the Commonwealth of Massachusetts and the DCR, their employees, and agents from liability for any damage or injuries resulting from my actions while participating in volunteer activities or projects approved or sponsored by the Department, that are found to be outside the scope of approved activities or projects.

I acknowledge that, by participating in such volunteer activities and projects, I have not received an appointment to state service, and I will not receive a salary or payment from the Commonwealth. As such, I understand that I am not entitled to Workers Compensation and that I cannot make any claims against the Department for any injury, loss, or damage to person (including bodily injury or death) or property suffered while involved in volunteer work or projects for the DCR and, further, that I will provide my own health insurance.

I recognize that MGL c. 21, §17G provides that, pursuant to the provisions, requirements, and limitations of MGL c. 258 and the guidelines adopted by DCR, I shall not be liable for injury or loss of property or personal injury or death caused by my negligent or wrongful act or omission while acting within the scope of my volunteer activities. However, I acknowledge that I will not be indemnified under MGL c. 258, §9 for intentional torts or for the violation of a person’s civil rights. I also acknowledge that in any litigation, the final determination of whether a person is considered an uncompensated employee is made the Attorney General’s Office.

This Release Form is valid from (Start Date of Service)(Required)

to (End Date of Service)(Required)

Which Park are you approved for volunteer stewardship?(Required)

What is the name of the DCR staff member that has approved your volunteer activity?(Required)

Name

First Last