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2. First Name*
3. Last Name*
5. Address1*
7. City*
8. State
9. Zip
11. Home Phone Number
12. Cell Phone Number
14. School
15. High School Graduation Year
17. Are you under the age of 18?
    -- Select One --YesNo
19. Email Address*
20. Are you interested in receiving e-mail notifications about volunteer opportunities?
    -- Select One --YesNo
22. Please mark all the programs you are interested in volunteering for:

    1. Special Events
    2. Tiny Tot Activities
    3. Senior Center
    4. Planting/Gardening
    5. Leading Outdoor Education Groups

    1. Emergency Preparedness
    2. Maintenance (Painting, Debris Clean-Up)
    3. Sports (Coaching/Scorekeeping)
    4. Office (Filing/Copying)
    5. Teen Programs
24. Volunteer Experience (please list any previous volunteer experience that you have had)
26. Do you need the City of Malibu to certify your total number of hours or duties worked?
    -- Select One --YesNo
28. Are you volunteering to fulfill the requirement of a court ordered program?
    -- Select One --YesNo
30. Do you have any limitations that the City should be aware of?
    -- Select One --YesNo
32. If yes, explain:
34. Have you ever had a job-related injury or illness?
    -- Select One --YesNo
36. If yes, explain
38. In case of emergency, please notify:
40. First Name*
41. Last Name*
43. Phone Number*
44. Alternate Phone Number
46. Space for additional details:
48. To be completed by a parent or guardian if volunteer is a minor
50. Individuals with disabilities requiring accommodations to participate in the programs in which you are registering must inform the City of Malibu at the time of registration is submitted. Individuals needing such accommodations must document the need for such accommodations to complete the registration form or participate in the registered program. The City of Malibu, as a matter of policy and law, will administer and conduct all City Programs in such a manner that no qualified individual with a disability will be excluded from participation in, or be denied benefits of services, programs, or activities of the City. If any individual feels that he/she or a group of individuals with a disability are being discriminated against, the person(s) or group(s) are encouraged to contact the City’s ADA office by phone at 310.456.2489, or in writing to Compliance Office, 23825 STUART RANCH ROAD, MALIBU, CA 90265. I fully understand that my participation in the above described program (the “Program”) exposes me to risk or personal injury, death, communicable diseases, illnesses, viruses, or property damage. I hereby acknowledge that I am voluntarily participating in this Program and agree to assume such risks. I hereby release, discharge and agree not to sue the City of Malibu, including its officers, employees and agents, (hereinafter the “City”) for any injury, death or damage to or loss of personal property arising out of, or in connection with, my participation in the Program from whatever cause, including the active or passive negligence of the City or any other participants in the program. The parties to this agreement understand that this document is not intended to release any part from any act or omission of “gross negligence,” as that term is used in applicable case law and/or statutory provision. In consideration of being permitted to participate in the Program, I hereby agree, for myself, my heirs administer, executors and assigns, that I shall indemnify, hold harmless, and defend the City from any and all claims, demands, actions or suits arising out of or in connection with my participation in the Program. I HAVE CARFULLY READ THIS RELEASE, HOLD HARMLESS AND AGREEMENT NOT TO SUE AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT IT IS A FULL RELEASE OF ALL LIABILITY AND SIGN AT MY OWN FREE WILL. I further agree and acknowledge that the City does not provide accident, medical, liability, workers’ compensation insurance or any other insurance for program participants. As participant, I hereby consent emergency treatment of myself as a result of accident or injury. I further agree to pay any and all costs incurred as a result of said treatment. I agree to carefully inspect and satisfy for myself that the facilities provided are reasonably safe for their intended use. I understand the City retains the right to use photos taken of me during activities for publicity purposes. My signature below certifies that I have read the Rules and Procedures on the attached sheet and that I agree to abide by all rules and regulations set forth therein.
52. I am the parent/guardian of the volunteer

    1. Yes
    2. No
54. Parent/Guardian First Name (or Volunteer Name if Over 18)
55. Parent/Guardian Last Name (or Volunteer Name if Over 18)
57. By checking this box I agree to the above statement.*

    1. I agree
Leave This Blank:


58. 1. Receive an email copy of this form.
59. Email address

    This field is not part of the form submission.

60. Submit Submit and Print

* indicates a required field