Committee Application

Use the follow application to apply for one of the City's Committees. Before you apply, you must attend three Committee Meetings and have your form signed by a Committee Representative. If you are under 18 and applying for a Committee, you will need your Parent/Legal Guardian's signature and completion of part of the application.

Age

Committee

Select Committee

Name

Business

Phone

Address

Address 2

City

State

ZIP Code

Date of Birth

List the dates of the meetings you have attended for this Committee. You must attend three meetings before applying for the Committee.

Meeting 1

Meeting 2

Meeting 3

List any current and/or relevant experience:

Educational Background

Volunteerism

Professional Background

Civic Experience

What Programs/Projects would you like to see improved or implemented?

Are you involved in any organizations or activities that may result in a Conflict of Interest if you are appointed to this Committee?

References

List the names and contact information for two references who are not officially connected with the City.

Reference One Name

Phone

Reference Two Name

Phone

Waiver and Release

I hereby choose to participate as a City of Mission Viejo (“City”) Volunteer. I understand that services are being offered on a voluntary basis without anticipation of renumeration. I am aware that this volunteer assignment may present risk of personal injury, death, communicable diseases, illnesses, viruses, or property damage/loss and agree to assume any such risks. I hereby release, discharge, and agree not to sue the City of Mission Viejo and/or its officers, officials, employees, agents, and volunteers for any injury, death, or damage to or loss of personal property arising out of, or in connection with my participation as a volunteer from whatever cause, including the active or passive negligence of the City or any other participants/volunteers. This document is not intended to release any party from any act or omission of “gross negligence”, as that term is used in applicable case law and/or statutory provision. In consideration for being permitted to participate as a volunteer, I hereby agree, for myself, my heirs, administrators, executors and assigns, that I shall indemnify and hold harmless the City of Mission Viejo and its officers, officials, employees, agents, and volunteers from any and all claims, demands, actions, or suits arising out of or in connection with my participation as a volunteer.

Photo Release: I hereby irrevocably give consent to the City, its employees, officers, officials, agents, and representatives to use, authorize and assign unlimited permission to use, post, publish, and republish for any purpose whatsoever by the City, or anyone authorized by City, any and all video and/or photographs, which the City, its employees, officers, officials, agents, or representatives have taken of me, negative or positive, without further compensation to me. All video and photographs, including negatives, prints, and digital storage of such shall constitute the property of City.

I HAVE CAREFULLY 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 IT OF MY OWN FREE WILL.

Signature

Sign above

Date Signed

Parent/Legal Guardian Information

The information below should be completed by your Parent/Legal Guardian.

I declare under penalty of perjury under the laws of the State of California that I am the parent or legal guardian of the Minor on this application. I hereby allow my child to participate in the this Committee.

I understand that services are being offered on a voluntary basis without anticipation of financial remuneration. I agree to assume all risk for injuries arising out of my child’s participation as a volunteer for the City. I acknowledge the above release and waiver of participant and agree with its contents. I agree that the City of Mission Viejo, and its officers, officials, employees, agents, and volunteers shall NOT be responsible or liable for any injury, damage, loss or expense to my child and/or mine or my child’s property incurred during my child’s participation as a volunteer. I further declare that I shall indemnify, defend, and hold harmless the City, its officers, officials, employees, agents, and volunteers from and against any and all Claims resulting from, incident to, or arising out of my child’s participation as a volunteer for the City of Mission Viejo, any and all risks assumed by my child and me above, and/or the breach of any promises, covenants, and/or representations made by me herein an/or in the above Release.

Parent/Legal Guardian

Minor's Name

Committee Applying For

Signature (parent/Legal Guardian if under age 18):

Sign above

Date Signed

Committee Application

MV Life