This form provides for the approval of volunteers for Midvale City. Midvale City complies with the Volunteer Government Workers Act of Utah. A volunteer is any person who donates service without pay or other compensation (except expenses actually and reasonably incurred as approved in writing by the city), and whose service is under direct city supervision.
You may not become an authorized volunteer of Midvale City unless your application has been approved by the appropriate department head of Midvale City and by the Human Resources Director. If you are approved as an authorized volunteer, you will be considered a government employee for the purposes of receiving workers’ compensation medical benefits, should you become injured while performing official volunteer service under direct city supervision, which shall be the exclusive remedy for all injuries and occupational diseases as provided under Title 34A, Chapter 2, Workers’ Compensation Act, and Chapter 3, Utah Occupational Disease Act. This applies to the operation of motor vehicles or equipment only if you are properly licensed and authorized by your supervisor.
By submitting this application, I hereby authorize Midvale City to perform a criminal history check. I certify I am at least eighteen (18) years of age or if between the ages of sixteen (16) and seventeen (17), this Agreement is also signed by my parent, natural guardian, or legal guardian (the “Guardian”); that I am in good health and in proper physical condition to perform the duties of the volunteer assignment for which I am applying. I certify that all statements in this application are true and complete to the best of my knowledge. I release Midvale City of any liability for use of this information in considering and review of my application. Any misstatement or omission may lead to my disqualification or dismissal.
I recognize that, if approved as a volunteer, I will be a representative of Midvale City. I agree to conduct myself in accordance with the Midvale City Policies and Procedures Manual, Part 6.1, Guidelines for Appropriate Conduct. I agree to follow the directions of the Midvale City employee supervising my service. As a condition of my participation, I agree to abide by state and municipal laws and regulations. I recognize that I have no property right in the volunteer assignment that I am applying for, I am not an employee of Midvale City (except as stated above), and that Midvale City may dismiss me for any reason, with or without cause. I recognize that as a volunteer, I understand that my participation in any activity on behalf of Midvale City is completely voluntary and that I am free to end my volunteer service at any time so long as (a) ending the activity prematurely does not represent a danger to myself or others and (b) I notify the Midvale City employee supervising my service.
I hereby expressly assume all such risks and responsibility for any damages, liabilities, losses, or expenses which I incur as a result of my participation with this volunteer assignment. I am also aware of the highly contagious nature of bacterial and viral diseases including the 2019 novel coronavirus disease (COVID-19) (collectively, the "Disease") and the risk that I may be exposed to or contract the Disease or other infectious diseases by my participation as a volunteer. I understand and acknowledge that such exposure or infection may result in serious illness, personal injury, permanent disability, death, or property damage. I acknowledge that this risk may result from or be compounded by the actions, omissions, or negligence of others, including Midvale City. I understand that while preventative measures may be implemented to reduce the spread of the Disease, Midvale City cannot guarantee that I will not become infected with the Disease or other infectious diseases while participating as a volunteer and that my participation may increase my risk of contracting the Disease.
I (or the Guardian, if I am under the age of 18) do hereby agree to forever release, indemnify, and hold harmless Midvale City, their agents, and assigns, to the full extent permitted by law, from any claims, damages, losses, liability, costs and expenses or any other charge or complaint related to this volunteer assignment. This form is binding upon my heirs, executors, administrators, and assigns.
