2024 Family Membership Waiver

FAMILY VOLUNTEER APPLICATION

Please enter the number of family members

A. Family Members Names

Please enter all family members names.

Additional Email Addresses for Family Memberships

Phone Number

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

B. If a volunteer is working with minors or will be driving to perform activities as outlined in the Stewardship Agreement they must fill out the questions below about criminal convictions. All other volunteers may skip Section B.

Have you ever been convicted of any crime (felony or misdemeanor)?

YES

Are you currently under charges for any crime?

YES

C. Emergency Contact:

First Name

Last Name

Emergency Contact Phone Number

D. Are You Under 18 Years of Age?

(If yes, a parent or guardian must sign below.)

YES

Volunteer's Date of Birth:

YYYY

PARENT/GUARDIAN PERMISSION (Only if Volunteer is under 18 years of age)

By checking this box, I acknowledge that I am providing my electronic signature and agreeing to the terms of this contract.

Parent/Guardian E-Signture Date

YYYY

Parent/Guardian Relationship to Volunteer:

Requests for reasonable accommodations necessary to insure full participation in our interview and selection process should be addressed to the NYS DEC Affirmative Action Officer, 625 Broadway, Albany, New York 12233.

THE NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION DOES NOT DISCRIMINATE ON THE BASIS OF RACE, COLOR, NATIONAL ORIGIN, GENDER, RELIGION, SEXUAL ORIENTATION, AGE, MARITAL STATUS OR DISABILITY IN EMPLOYMENT OR PROVISION OF SERVICES.

This form must be completed for each volunteer. Completed volunteer application forms must be forwarded to the Respective Management Authority or his/her designee who will maintain copies of completed volunteer applications for the life of the Agreement, plus 3 years. The information on this form is necessary to be certain that volunteers are covered by the Workers’ Compensation.

Volunteers are defined by:

1) individuals performing tasks traditionally reserved for volunteers, i.e., they are not being used to supplant paid staff in performing staff activities; 2) the individuals are not being required to work certain hours or perform duties involuntarily; 3) the individuals receive no remuneration for their activities. Volunteers under 18 years of age are not required to obtain employment certificates (working papers).

Questions concerning this form or the VSA Program may be directed to the DEC contact person. DEC Contacts may be found by accessing the Regional Office Contacts link at www.dec.ny.gov/about/50230.html or by calling (518) 473-9518.

PERSONAL PRIVACY PROTECTION NOTIFICATION

The information you are providing on this application is being requested to meet the Department’s legal obligations. It will be used in accordance with Section 96 of the Public Officers Law. Failure to provide the requested information may result in your disqualification as a volunteer. The information will be maintained by the Director of Personnel, Department of Environmental Conservation, 625 Broadway, Albany, New York 12233 (518) 402-9273.

ACKNOWLEDGMENT & RELEASE - Saratoga Mountain Bike Association

By purchasing membership, I acknowledge to Saratoga Mountain Bike Association (“SMBA”), that all activities sponsored or conducted by SMBA may be hazardous and may result in temporary or permanent loss, damage, or injury (mental or physical) or death. On behalf of myself, my executors, administrators, heirs, next of kin, successors, and assigns, I hereby: A. Waive, release, and discharge SMBA, and its respective officers, directors, agents, employees, and volunteers from any and all liability, damages, claims, demands, losses, or causes of action of any and every kind, including for my death, disability, personal injury, property damage, property theft or actions of any kind which may hereafter accrue to me and/or my estate, arising out of or relating to any activities promoted or sponsored by, or associated with SMBA; B. Indemnify and hold harmless SMBA, and its respective officers, directors, agents, employees, and volunteers from and against any and all liabilities, damages, claims, demands, losses, or causes of action made by other individuals or entities as a result of any involvement in or actions during any activities promoted or sponsored by, or associated with SMBA; C. Assume full responsibility for the risk of bodily injury, death, disability, or property damage arising out of or related to such activities, whether caused by my negligence or otherwise. I acknowledge that the releases in this agreement shall bar any and all actions, fees, damages, losses, claims, liabilities and demands of every nature and character, whether known or unknown. Mountain biking is an inherently dangerous activity and by signing below I acknowledge that I am aware of the risks, I understand and appreciate the nature of those risks and I voluntarily assume the risks associated with off-road mountain biking. Variations in terrain or weather conditions include but are not limited to ruts, bumps, moguls, other persons using the trails, logs, bridges, rocks, forest growth, debris, branches, leaves, trees, roots, stumps or other natural objects or man-made objects. The preceding may be present and I will exercise caution when using the SMBA trails. I will keep myself, my equipment, and my bicycle completely under control at all times in such a manner that will not jeopardize my safety or the safety of others. I assume full responsibility for any or all personal losses, damages, and injuries (mental or physical) including those resulting in death, which may occur, even as the result of my own negligence, lack of knowledge and/or the negligence or lack of knowledge of SMBA, its officers, guides, group members, representatives or agents. I agree to be solely responsible for my own safety and to take every precaution to provide for my own safety and well being, while participating in SMBA activities, including using proper protective gear such as a helmet. I will receive a SMBA trail map and using the trail ratings on it I will not ride beyond my limits or ability to overcome variations in slope, trail configuration and surface or subsurface conditions which may be caused or altered by weather or trail maintenance work. I agree that the only trail maintenance, trail work, new trail cutting, or building I will participate in will be approved by SMBA, at SMBA trail days, or in fulfillment of my adopt-a-trail volunteer activities. I acknowledge that I have read and understand the above release, waiver, and indemnification, and intend my signature below to be a complete and unconditional release of all liability to the broadest and most inclusive extent allowed by New York state law. By purchasing a membership, I confirm that if I failed to understand anything in this document, I have sought and received an explanation of its meaning and significance to my complete satisfaction.

Volunteer's E-Signature

By checking this box, I certify that the information provided on this Family Membership Volunteer form is accurate to the best of my knowledge. I understand that any knowingly false statement may result in the termination of my volunteer service.

Volunteer’s E-Signature Date

YYYY

2024 Family Membership Waiver

FAMILY VOLUNTEER APPLICATION

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